Who refuses the diagnostic assessment for dementia in primary care?
Who refuses the diagnostic assessment for dementia in primary care?
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DOI：
10.1002/gps.1524
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发表时间：
2006-06-01
影响因子：
4
通讯作者：
Hendrie, Hugh C.
中科院分区：
文献类型：
--
作者：
Boustani, Malaz;Perkins, Anthony J.;Hendrie, Hugh C.
目的 初级保健中痴呆症的早期筛查和检测仍存在争议。通过筛查仪器确定为认知障碍的患者中至少有一半不符合痴呆症标准，并且一些患者在筛查呈阳性后拒绝进一步评估。本研究的目的是确定筛选后拒绝痴呆症临床诊断评估的患者的特征。设计横断面研究。设置印第安纳波利斯的七个初级保健实践中心。参与者 434 名 65 岁及以上的痴呆症筛查阳性患者，平均年龄为 74.6 岁，其中 67% 为女性，68% 为非裔美国人。主要结果衡量患者对 接受痴呆症诊断评估，包括神经心理学测试、护理人员访谈和病历审查。结果 在痴呆症筛查结果呈阳性的患者中，大约一半 (47.7%) 拒绝进一步评估以确认其筛查结果。在双变量分析中，与拒绝痴呆症评估较高概率相关的可能因素是年龄较大和筛查得分较高。在多元逻辑回归模型中，在筛查仪器的时间方向上表现良好与拒绝痴呆症诊断评估的概率较高相关（OR = 1,37；p = 0.001）。此外，80 岁及以上的非洲裔美国患者比 80 岁以下的非洲裔美国人更有可能拒绝诊断评估（OR = 3.1，p < 0.001），而白人患者则没有显着的年龄相关性（OR = 0.9，p = 0.728）。 结论 自认为没有认知症状的老年初级保健患者尽管筛查结果呈阳性，仍拒绝痴呆诊断评估。在实施任何广泛的痴呆症筛查举措之前，我们必须提高对决策过程的理解，该过程推动患者对痴呆症筛查和诊断的益处和风险产生信念和行为。版权所有 (c) 2006 John Wiley & Sons, Ltd.
Objective Early screening and detection of dementia in primary care remains controversial. At least half of the patients identified as cognitively impaired by screening instruments do not meet criteria for dementia and some patients refuse further evaluation following a positive screen. The aim of this study was to identify the characteristics of patients who refuse a clinical diagnostic assessment for dementia after screening.Design Cross sectional study.Setting Seven primary care practice centers in Indianapolis.Participants Four hundred and thirty-four individuals aged 65 and older who screened positive for dementia with a mean age of 74.6, 67% women, and 68% African-American.Main outcome measure Patients' acceptance of undergoing a dementia diagnostic assessment that included neuropsychological testing, caregiver interview, and medical chart review.Results Among patients with positive screening results for dementia, approximately half (47.7%) refused further assessment to confirm their screening results. In a bivariate analysis, possible factors associated with a higher probability of refusing dementia assessment were older age and better screening score. In a multiple logistic regression model, performing well on the temporal orientation of the screening instrument was associated with a higher probability of refusing diagnostic assessment for dementia (OR = 1,37; p = 0.001). Also, African-American patients aged 80 and older were more likely to refuse the diagnostic assessment than African-Americans less than 80 years of age (OR = 3.1, p < 0.001), while there was no significant age association for white patients (OR = 0.9, p = 0.728).Conclusions Older primary care patients who perceived themselves as having no cognitive symptoms refused dementia diagnostic assessment despite their positive screening results. We must improve our understanding of the decision-making process driving patients' beliefs and behaviors about the benefits and risks of dementia screening and diagnosis before implementing any broad-based screening initiatives for dementia. Copyright (c) 2006 John Wiley & Sons, Ltd.