记忆门诊“环路式体系”对阿尔茨海默病管理的应用效果

Effect of application of the loop system in memory clinic on Alzheimer's disease management

目的探讨记忆门诊“环路式体系”对阿尔茨海默病管理的应用效果。方法回顾性分析“环路式体系”开展前(2017年1月至12月)和开展后(2020年1月至12月)于广州市第一人民医院神经内科首次就诊并确诊为阿尔茨海默病的298例患者的临床资料,将2020年1月至12月首诊的患者作为研究组(179例),将2017年1月至12月首诊的患者作为对照组(119例)。按照国内外相关指南和共识,结合自身特点,规范记忆门诊管理体系,形成“社区-门诊筛查-诊断-综合干预-回归社区”的“环路式体系”综合管理模式。比较两组首诊时选择记忆门诊的患者比例、痴呆严重程度、辅助检查和相关评估量表的完成率。结果研究组首诊选择记忆门诊就诊率高于对照组,差异有统计学意义(P<0.05),研究组的轻度认知障碍比例高于对照组,差异有统计学意义(P<0.05),研究组的验血套餐、神经精神量表(NPI)、蒙特利尔认知评估量表(MoCA)、日常生活能力量表(ADL)完成率和脑脊液生物标志物送检率均高于对照组,差异有统计学意义(P<0.05);两组的简明精神状态量表(MMSE)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)和影像学检查完成率比较,差异无统计学意义(P>0.05)。结论记忆门诊“环路式体系”促进疾病早期筛查、规范化诊治,尤其是对疾病干预前移有一定的促进作用。

Objective To explore the effect of application of the loop system in memory clinic on Alzheimer′s disease management.Methods A retrospective analysis was performed on the clinical data of 298 patients diagnosed with Alzheimer′s disease who were admitted to the Department of Neurology of Guangzhou First People′s Hospital for the first time before the implementation of"loop system"(from January 2017 to December)and after the implementation of"loop system"(from January 2020 to December).Patients first diagnosed from January 2020 to December were included in the study group(179 cases),and patients first diagnosed from January 2017 to December were included in the control group(119 cases).According to the relevant guidelines and consensus at home and abroad,a loop system consisting of community,outpatient screening and diagnosis,comprehensive intervention and return to the community was formed as a comprehensive management mode through standardizing the memory clinic management system,in combination with their own characteristics.The rate of patients who selected memory clinic for the first visit,severity of dementia,completion rates of auxiliary examination and related assessment scales were compared between the two groups.Results The rate of patients who selected memory clinic for the first visit of study group was higher than that in the control group,with statistically significant difference(P<0.05).The proportion of mild cognitive impairment in study group was higher than that in control group,and the difference was statistically significant(P<0.05).The completion rate of blood test package,neuropsychiatric inventory(NPI),Montreal cognitive assessment(MoCA),activity of daily living scale(ADL),the delivery rate of cerebrospinal fluid biomarkers were higher than those in the control group,the differences were statistically significant(P<0.05).There were no significant difference in the completion rates of imaging examination,mini-mental state examination(MMSE),Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)between the two groups(P>0.05).Conclusion The"loop system"of memory clinic can promote the early screening and standardized diagnosis and treatment of diseases,especially the advancement of disease intervention.