Impediments to timely diagnosis of Alzheimer's disease in African Americans
Impediments to timely diagnosis of Alzheimer's disease in African Americans
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DOI：
10.1111/j.1532-5415.2005.53569.x
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发表时间：
2005-11-01
影响因子：
6.3
通讯作者：
Bowles, T
中科院分区：
文献类型：
--
作者：
Clark, PC;Kutner, NG;Bowles, T
这项研究的目的是在一组在市中心诊所和郊区记忆评估诊所就诊的非裔美国患者及其照顾者中确定阿尔茨海默病(AD)的早期护理模式。对79名确诊为阿尔茨海默病患者的照顾者进行了访谈。收集了从注意到第一个AD症状到认识到存在问题的延迟以及从认识到问题的认识到第一次医生咨询的延迟的数据。患者和照顾者的教育程度较低，虽然两家诊所的患者的MMSE得分没有差异，但市中心诊所的患者最近被诊断出来的时间比郊区诊所的患者晚；不同诊所的照顾者在认识到问题和咨询医生方面的中位延迟也是相似的。在注意到症状和问题认识之间，以及在问题认识和医生咨询之间，延迟了长达7年的时间。尽管去郊区诊所就诊的患者比去市中心诊所就诊的患者更有可能看过医生，但他们并不比去市中心诊所就诊的患者更有可能之前被诊断为AD。在照顾患有阿尔茨海默病的非裔美国人的家庭中，缺乏医生联系可能会很普遍。医生咨询更多的是受过高等教育的家庭的特点，但可能不会为患者带来正确的诊断。需要加紧努力，将非裔美国人家庭与医生联系起来，实现更及时的AD诊断，使家庭能够了解疾病，规划患者安全，并制定长期计划。
The purpose of this study was to identify early patterns of care for Alzheimer's disease (AD) in a cohort of African-American patients and their caregivers presenting at an inner city clinic and a suburban memory assessment clinic. Caregivers (N=79) of patients diagnosed with probable AD were interviewed. Data were collected about the delay from noticing first AD signs until recognition that a problem existed and delay from problem recognition until first physician consultation. Patients and caregivers had lower educational status, and patients had been diagnosed more recently at the inner city clinic than at the suburban clinic, although MMSE scores of patients at the two clinics did not differ; median delays in caregivers' recognizing a problem and in consulting a physician were also similar across clinics. Delay was as long as 7 years between noticing symptoms and problem recognition and between problem recognition and physician consultation. Although patients attending the suburban clinic were more likely to have previously seen a physician than those attending the inner city clinic, they were no more likely to have received a prior diagnosis of AD. Lack of physician contact is likely to be widespread in families caring for African Americans with AD. Physician consultation is more characteristic of more highly educated families but may not yield a correct diagnosis for the patient. Intensive efforts are needed to connect African-American families with physicians and to achieve more timely diagnosis of AD to enable families to understand the illness, plan for patient safety, and make long-term plans.