JAMA子刊:农村和城市在诊断早发痴呆症方面的差异

2022-08-07 MedSci原创 MedSci原创

与城市地区的患者相比,农村地区的早发ADRDs新患者不太可能接受神经心理学测试或访问心理学家,但更有可能完全由初级保健医生诊断和治疗。

阿尔茨海默病和相关痴呆症(ADRDs)是导致记忆、认知和独立功能丧失的衰弱状况。大约6%的患者在30至65岁之间患有早发性ADRDs,后者与更积极的临床过程有关,但与晚发性ADRDs相比,认知和功能衰退更快。

为了研究农村与城市早期ADRD患者在诊断和症状管理服务使用方面的差异,来自美国的学者开展了一项横断面研究。纳入的患者为40-64岁的早发ADRD患者,暴露因素为农村居住地。主要结果和措施 在新的、早期发病的ADRD患者中,收集了在最初诊断(索引日)或索引日之后90天或更短时间内进行的心理评估和神经心理学测试的使用情况,以及在索引日之前180天内脑成像的使用情况。

结果显示,在71799名早发ADRD患者中(平均[SD]年龄,56.34[6.05]岁;39 231名女性[54.64%]),8430人有新的早发ADRD(平均[SD]年龄,55.94[6.30]岁;16 512名女性[56.65%])。农村地区与城市地区的早发ADRD新患者在使用心理评估、影像学研究或访问神经学家或精神病学家方面没有统计学上的显著差异。

然而,与城市地区的患者相比,农村地区的新患者不太可能接受神经心理学测试(OR=0.83;95%CI,0.70-0.98)或访问心理学家(OR=0.72;95%CI,0.60-0.85)。然而,与城市地区的患者相比,农村地区的早发ADRDs新患者更有可能只去看PCP诊断和症状管理(OR=1.40;95% CI,1.19-1.66)。

本研究发现,与城市地区的患者相比,农村地区的早发ADRDs新患者不太可能接受神经心理学测试或访问心理学家,但更有可能完全由初级保健医生诊断和治疗。这些发现表明,可能需要努力,如临床医生教育或对初级保健医生的远程咨询指导,以提高农村地区获得专家服务的机会。

 

参考文献:

Rural-Urban Disparities in Diagnosis of Early-Onset Dementia. JAMA Netw Open. 2022;5(8):e2225805. doi:10.1001/jamanetworkopen.2022.25805

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1836316, encodeId=d24e183631671, content=<a href='/topic/show?id=4613e1212fc' target=_blank style='color:#2F92EE;'>#痴呆症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71212, encryptionId=4613e1212fc, topicName=痴呆症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=726030, createdName=Boyinsh, createdTime=Mon Oct 24 18:39:38 CST 2022, time=2022-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1664152, encodeId=a828166415262, content=<a href='/topic/show?id=a20c59283e5' target=_blank style='color:#2F92EE;'>#早发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59283, encryptionId=a20c59283e5, topicName=早发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=06c425715601, createdName=ms7258648636991762, createdTime=Thu Jul 13 16:39:38 CST 2023, time=2023-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405082, encodeId=19e7140508233, content=<a href='/topic/show?id=2c4a30e76c7' target=_blank style='color:#2F92EE;'>#农村#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30776, encryptionId=2c4a30e76c7, topicName=农村)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b76a2518787, createdName=daviiliu, createdTime=Mon Aug 08 06:39:38 CST 2022, time=2022-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243637, encodeId=bebf124363eaa, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Aug 06 18:39:38 CST 2022, time=2022-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1247165, encodeId=f34a124e16591, content=老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Sat Aug 06 18:39:38 CST 2022, time=2022-08-06, status=1, ipAttribution=)]
    2022-10-24 Boyinsh
  2. [GetPortalCommentsPageByObjectIdResponse(id=1836316, encodeId=d24e183631671, content=<a href='/topic/show?id=4613e1212fc' target=_blank style='color:#2F92EE;'>#痴呆症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71212, encryptionId=4613e1212fc, topicName=痴呆症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=726030, createdName=Boyinsh, createdTime=Mon Oct 24 18:39:38 CST 2022, time=2022-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1664152, encodeId=a828166415262, content=<a href='/topic/show?id=a20c59283e5' target=_blank style='color:#2F92EE;'>#早发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59283, encryptionId=a20c59283e5, topicName=早发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=06c425715601, createdName=ms7258648636991762, createdTime=Thu Jul 13 16:39:38 CST 2023, time=2023-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405082, encodeId=19e7140508233, content=<a href='/topic/show?id=2c4a30e76c7' target=_blank style='color:#2F92EE;'>#农村#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30776, encryptionId=2c4a30e76c7, topicName=农村)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b76a2518787, createdName=daviiliu, createdTime=Mon Aug 08 06:39:38 CST 2022, time=2022-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243637, encodeId=bebf124363eaa, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Aug 06 18:39:38 CST 2022, time=2022-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1247165, encodeId=f34a124e16591, content=老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Sat Aug 06 18:39:38 CST 2022, time=2022-08-06, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1836316, encodeId=d24e183631671, content=<a href='/topic/show?id=4613e1212fc' target=_blank style='color:#2F92EE;'>#痴呆症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71212, encryptionId=4613e1212fc, topicName=痴呆症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=726030, createdName=Boyinsh, createdTime=Mon Oct 24 18:39:38 CST 2022, time=2022-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1664152, encodeId=a828166415262, content=<a href='/topic/show?id=a20c59283e5' target=_blank style='color:#2F92EE;'>#早发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59283, encryptionId=a20c59283e5, topicName=早发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=06c425715601, createdName=ms7258648636991762, createdTime=Thu Jul 13 16:39:38 CST 2023, time=2023-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405082, encodeId=19e7140508233, content=<a href='/topic/show?id=2c4a30e76c7' target=_blank style='color:#2F92EE;'>#农村#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30776, encryptionId=2c4a30e76c7, topicName=农村)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b76a2518787, createdName=daviiliu, createdTime=Mon Aug 08 06:39:38 CST 2022, time=2022-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243637, encodeId=bebf124363eaa, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Aug 06 18:39:38 CST 2022, time=2022-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1247165, encodeId=f34a124e16591, content=老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Sat Aug 06 18:39:38 CST 2022, time=2022-08-06, status=1, ipAttribution=)]
    2022-08-08 daviiliu
  4. [GetPortalCommentsPageByObjectIdResponse(id=1836316, encodeId=d24e183631671, content=<a href='/topic/show?id=4613e1212fc' target=_blank style='color:#2F92EE;'>#痴呆症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71212, encryptionId=4613e1212fc, topicName=痴呆症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=726030, createdName=Boyinsh, createdTime=Mon Oct 24 18:39:38 CST 2022, time=2022-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1664152, encodeId=a828166415262, content=<a href='/topic/show?id=a20c59283e5' target=_blank style='color:#2F92EE;'>#早发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59283, encryptionId=a20c59283e5, topicName=早发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=06c425715601, createdName=ms7258648636991762, createdTime=Thu Jul 13 16:39:38 CST 2023, time=2023-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405082, encodeId=19e7140508233, content=<a href='/topic/show?id=2c4a30e76c7' target=_blank style='color:#2F92EE;'>#农村#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30776, encryptionId=2c4a30e76c7, topicName=农村)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b76a2518787, createdName=daviiliu, createdTime=Mon Aug 08 06:39:38 CST 2022, time=2022-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243637, encodeId=bebf124363eaa, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Aug 06 18:39:38 CST 2022, time=2022-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1247165, encodeId=f34a124e16591, content=老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Sat Aug 06 18:39:38 CST 2022, time=2022-08-06, status=1, ipAttribution=)]
    2022-08-06 肿瘤克星

    JAMA上文章都是顶级的,谢谢梅斯及时上新

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1836316, encodeId=d24e183631671, content=<a href='/topic/show?id=4613e1212fc' target=_blank style='color:#2F92EE;'>#痴呆症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71212, encryptionId=4613e1212fc, topicName=痴呆症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=726030, createdName=Boyinsh, createdTime=Mon Oct 24 18:39:38 CST 2022, time=2022-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1664152, encodeId=a828166415262, content=<a href='/topic/show?id=a20c59283e5' target=_blank style='color:#2F92EE;'>#早发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59283, encryptionId=a20c59283e5, topicName=早发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=06c425715601, createdName=ms7258648636991762, createdTime=Thu Jul 13 16:39:38 CST 2023, time=2023-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405082, encodeId=19e7140508233, content=<a href='/topic/show?id=2c4a30e76c7' target=_blank style='color:#2F92EE;'>#农村#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30776, encryptionId=2c4a30e76c7, topicName=农村)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b76a2518787, createdName=daviiliu, createdTime=Mon Aug 08 06:39:38 CST 2022, time=2022-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243637, encodeId=bebf124363eaa, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Aug 06 18:39:38 CST 2022, time=2022-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1247165, encodeId=f34a124e16591, content=老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Sat Aug 06 18:39:38 CST 2022, time=2022-08-06, status=1, ipAttribution=)]
    2022-08-06 neuro.Dr

    老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!

    0

相关资讯

Alzheimer&Dementia:老年痴呆生物标志物中p-tau或可早期可视化

磷酸化tau液体生物标志物位点存在于早期神经纤维缠结成熟水平,并可能解释为什么这些液体生物标志物措施在症状发生前就被观察到。

Brain-小血管疾病和痴呆标志物,如何影响大脑白质病变?

纤维密度能捕捉到脑小血管疾病的影响,而纤维束的横截面则主要由神经变性决定

Exp Gerontol:老年人摄入酪蛋白肽可以改善其认知功能

痴呆症在老龄化社会中越来越普遍,执行功能是随着老龄化而衰退的认知过程之一。人类和动物研究表明,酪蛋白肽(酪蛋白水解物)对认知功能有积极影响。

Movement disorders:新突变,和路易体痴呆高度相关

有害的GRN突变是家族性LBD的一个罕见原因

Alzheimer&Dementia:听声辨智——从语音记录中自动检测轻度认知障碍和痴呆

该研究所提出的方法提供了一个基于记录的神经心理测试的MCI和痴呆的全自动识别,提供了一个开发远程筛查工具的机会,可以很容易地适应任何语言。

Alzheimer&Dementia:大脑氧提取分数变化与血管和阿尔茨海默病的关系

由此可见,老年人的OEF纵向变化主要与血管病变有关。

拓展阅读

IJNS:基于生命历程模型的多领域干预可降低老年人痴呆的风险

基于生命历程模型的多领域干预是可行的,有可能降低中国高危老年人患痴呆症的风险,改善他们的认知功能。

ART:视网膜血管的变化有望为观测阿尔茨海默病进程提供一个窗口

视网膜血管测量并不能代表非痴呆个体的脑血管损伤,而鼻侧象限的VD与海马萎缩相关,与淀粉样蛋白状态无关。

Neurology:利用基于弥散的神经炎症成像技术研究阿尔茨海默病的白质神经炎症

WM神经炎症在AD临床症状出现之前就已发生改变,并且与淀粉样变性相互作用。

Nature子刊:与记忆力训练相比,瑜伽对老年痴呆高危妇女的认知和免疫学影响

KY 对 SCD 有临床和生物学上的益处,将认知的变化与瑜伽的抗炎作用联系起来。

BMJ子刊:心血管风险负担、痴呆症风险和大脑结构成像标记——英国生物数据库研究

心血管风险负担与痴呆风险的正相关关系也适用于主要的痴呆亚型。心血管风险负担与全因痴呆的关系在很大程度上与心血管疾病的发病和痴呆的遗传易感性无关。

IJNS:老年痴呆症患者营养不良患病率和营养不良风险

结果表明,大约三分之一的痴呆症老年人存在营养不良,近一半的老年人有营养不良的风险。