Cognitive Assessment of Older Primary Care Patients with and Without Memory Complaints

BACKGROUND Dementia screening is currently recommended only for symptomatic patients. OBJECTIVE To evaluate memory complaints, a mental status test, and several cognitive tests as dementia screens in primary care. DESIGN Cross-sectional clinical epidemiologic study. PARTICIPANTS Three hundred thirty-nine comprehensively assessed, primary care patients aged ≥65 years. MEASUREMENTS Memory complaints were abstracted from chart review. Scores on Mini-Mental State Examination (MMSE) and domain-specific cognitive testing were compared to a dementia diagnosis based on Clinical Dementia Rating score ≥ 1, and areas under the receiver operating characteristic curves (AUC) were calculated. Classification and regression tree analyses were performed on memory complaints and tests with the highest AUCs. RESULTS Of 33 patients with dementia, only 5 had documented memory complaints. In 25 patients with documented memory complaints, no cognitive tests further improved identification of the 5 with dementia. In 28 patients with dementia but without memory complaints, an MMSE score < 20 identified 8 cases; among those with MMSE scores 20–21, a visual memory test identified a further 11 cases. Further cognitive testing could not detect 9 dementia cases without memory complaints and with MMSE scores ≥ 22. CONCLUSIONS In older primary care patients with memory complaints, cognitive screening does not help identify those who require further examination for dementia. Most patients with dementia do not report memory complaints. In these asymptomatic individuals, general mental status testing, supplemented by a memory test when the mental status score is equivocal, will identify lower-scoring patients who need dementia assessment. However, high-scoring asymptomatic dementia cases will remain undetected.     

阿尔茨海默病各种临床记忆检测方法的评价

目的评价各种临床记忆检测方法对阿尔茨海默病(Alzheimer’s disease,AD)诊断的临床效度,从而组合出最适宜AD患者的一套记忆力检测量表。方法以北京市十五攻关项目中研究的患者为背景,对正常老年人1 584例(常模组),AD患者351例(AD组),应用各种记忆力检测量表进行临床分析。结果各种记忆力检测量表对AD的记忆力检测均有较好的临床效度。结合记忆力检测量表的敏感性、特异性、临床可行性及不同的记忆模式,以常模组记忆总得分的第5百分位为分界值,联合各量表的记忆检测,轻度AD患者敏感性为82.57%,特异性为93.29%;检测中度AD患者的敏感性为85.46%,特异性为91.63%。结论联合各量表的记忆检查对AD患者的记忆力检测,敏感性及特异性高,对AD的轻、中度分界有辅助作用。     

Urban-rural differences in a memory disorders clinical population

OBJECTIVES: To compare patient characteristics and family perceptions of patient function at one urban and one rural memory disorders clinic. DESIGN: Secondary, cross-sectional data analyses of an extant clinical database. SETTING/PARTICIPANTS: First time visits (n = 956) at two memory disorders clinics. MEASUREMENTS: Patient and family-member demographics and assessment results for the Mini-Mental State Examination (MMSE), instrumental activities of daily living (IADLs), activities of daily living (ADLs), the Memory Change and Personality Change components of the Blessed Dementia Rating Scale, and the Revised Memory and Behavior Problems Checklist. RESULTS: In both clinics, patients and family members were more likely female. The typical urban clinic patient was significantly more likely to be living in a facility and more educated than the typical rural patient. Urban and rural patients did not show significant differences in age- and education-adjusted MMSE scores or raw ADL/IADL ratings, but the urban family members reported more memory problems, twice as many personality changes, more-frequent behavior problems, and more adverse reactions to problems. CONCLUSION: Physicians who practice in both urban and rural areas can anticipate differences between patients, and their families, who seek a diagnosis of memory disorders. Our most important finding is that despite similarities in reported functional abilities, urban families appear to be more sensitive to and more distressed by patients' cognitive and behavioral symptoms than rural families. These differences may reflect different underlying needs, and should be explored in further research.     

Treatment of cobalamin deficiency in dementia, evaluated clinically and with cerebral blood flow measurements

We investigated the relation between cobalamin deficiency, clinical changes and brain function in dementia patients. On admittance to the clinic, 24 patients had cobalamin deficiency, and dementia with additional symptoms of delirium. During cobalamin supplementation, the patients underwent repeated regional cerebral blood flow (rCBF) studies, psychiatric evaluations, and in some cases assessment with MMSE and the Organic Brain Syndrome scale. Fifteen patients who showed mild to moderate dementia improved clinically, and also showed a concomitant increase in their general CBF after treatment. In contrast, 9 patients who were severely demented showed no obvious clinical improvement, and no general blood flow change, although some regional flow increases were seen in sensory motor areas. We conclude that symptoms which probably indicated superimposed delirium such as clouding of consciousness, disorientation and clinical fluctuation, responded to the vitamin B12 supplementation, while the underlying dementia condition remained basically unchanged. The clinical improvement was also mirrored in general and focal rCBF changes.     

An overview and prospect of demented outpatient care in a department of geriatric medicine: report based on statistical review of the memory clinic at the geriatric outpatient unit of the Nagoya University Hospital

AIM: Although there are many reports regarding the status of memory clinics in Japan, most are from the clinical departments of psychiatry or neurology, and there are few from the geriatric outpatient clinics. This study aimed to review the status of the memory clinic at the geriatric outpatient unit of a university hospital and also to compare the results with other reports. METHODS: Patient records of the memory clinic at the geriatric outpatient unit of the Nagoya University Hospital between January 2000 and June 2006, which included clinical information and neuropsychological profiles were extensively reviewed for statistical analyses. Of the patients who first visited the memory clinic between January 2004 and June 2006, prior written consent are obtained from 232 outpatients, among which 223 individuals who had intact sets of data were subjected to detailed analyses. RESULTS: During the period investigated, we had a total of 778 visits by 577 patients. The characteristics of patients were: age: 74.5+/-8.3 years; MMSE: 23.8+/-4.7; education year: 10.7+/-2.9. Clinical profiles of the patients who visited during the most recent 2.5 years were as follow: cognitively normal, 8.1%; dementia of Alzheimer's type, 45.3%; vascular type, 5.4%; mixed type, 2.2%; frontotemporal dementia, 3.1%; mild cognitive impairment, 15.7%, and others. CONCLUSION: Compared with previous reports from other institutions, we observed that the visitors to our geriatric memory clinic had a relatively higher educational background with earlier stages of dementing disorders, which also included pre-clinical cognitive impairment.     

Interdisciplinary research strategies in geriatric psychiatry--studies and results in dementia and depressed patients

Eighty-one patients (mean age: 66 +/- 9 years) who had been in gerontopsychiatric in-patient care were included in the study. As well as physical, psychiatric and neurological examinations, EEG, brain CT scanning and the determination of the Ischemic Scale were performed, in order to confirm the clinical diagnosis of dementia of Alzheimer type (DAT), dementia of vascular type (DVT) or multi-infarct dementia (MID), and depression in old age, as based on the DSM III criteria. A comprehensive psychological test battery was administered, to one section of the subjects. Our results indicate that EEG and Ischemic Score can differentiate patients with DAT and DVT to a satisfactory degree, whereas CT findings and psychometric assessment were apt to confirm the overall diagnosis of dementia (DAT/DVT) and depression. Patients with dementia showed memory impairment to a greater extent than depressive patients, as could be proved by a memory test (Syndrom-Kurztest). However, a dementia screening test (Information-Memory-Concentration Test) could more accurately differentiate dementia and depression. The application of a comprehensive psychometric testing procedure did not prove to be an effective diagnostic tool in the assessment of various stages of dementia. Short dementia tests and rating scales seem to be appropriate to distinguish depression from dementia, especially in cases of mild to moderate dementia. In patients with very mild and insignificant organic brain disturbances these screening methods fall short of diagnostic validity. Beyond this, there is a current need for assessment instruments in the evaluation of alterations in personality and affectivity, such as are seen in depression.     

Comprehensive geriatric assessment in female elderly patients with Alzheimer disease and other types of dementia

The most visible manifestation of dementia is the progressive inability to activities of daily living (ADL) and to instrumental activities of daily living (IADL). The comprehensive geriatric assessment (CGA) is the validated and recommended instrument to a correct evaluation and decision making in elderly patients. To judge if the decline in cognitive functions is associated with a worsening in functional, emotional and clinical status measured by CGA, we also compared CGA in the same patients stratified for mild, moderate and severe dementia. From September 2004 to November 2005 we studied 47 institutionalized female patients with Alzheimer's disease (AD) and other types of dementia. Mean age was 83.70+/-0.88 years (range 70-101). Their multidimensional evaluation was performed by the CGA. We evaluated geriatric syndromes (AGS, 2004), polypharmacy, frailty, hemoglobin (Hb), serum creatinine (CR) and white blood cells (WBC). We stratified the population in 3 groups for the mini mental state examination (MMSE): severe (MMSE 0-9; 5 patients), moderate (MMSE 10-29; 23 patients) and mild dementia group (MMSE 20-30; 19 patients), and searched for statistical differences in the parameters of CGA. MMSE was significantly related to dependence in ADL (mean=x=1.85), IADL (x=0.57), cumulative illness rating scale-geriatrics (CIRS-G) (x=9.55), geriatric depression scale (GDS) (x=8.71), geriatric syndromes (x=2.49), Hb, CR, WBC and number of drugs (x=6.51, range 2-15) (p=0.001). MMSE low score was also correlated with a worse mini nutritional assessment (MNA) (x=19.5; p=0.003). Frail patients were 61.7%. We found a statistically significant difference in the prevalence of geriatric syndromes between mild vs. moderate dementia group (p=0.02). Mild vs. moderate group, and moderate vs severe group were significantly different concerning Hb levels (p=0.009 and 0.002, respectively). Patients with severe cognitive impairment are more likely to be dependent at ADL and IADL; to present a larger number of comorbidity and geriatric syndromes; to have lower !evels of Hb and higher levels of CR; to be in a worse nutritional status and to take a larger number of drugs. Polypharmacy maybe related to high comorbidity but the risk of irrational drug use should be evaluated. We suggest single testing with CGA as an effective tool providing a comprehensive assessment of elderly, and able to detect unaddressed corrigible problems.     

Donepezil provides greater benefits in mild compared to moderate Alzheimer's disease: Implications for early diagnosis and treatment

We assessed the cognitive and functional outcomes of donepezil treatment in mild versus moderate Alzheimer's disease (AD) patients. We performed a 6-month prospective, observational, multicenter study of the progression of cognitive and functionality abilities in a large sample patients with AD who initiated treatment with donepezil in monotherapy. According to baseline mini mental state examination (MMSE), patients were divided in two groups: mild AD (MMSE ≥ 21) and moderate AD (MMSE < 21). Patients were evaluated with the memory alteration test (M@T) and the Alzheimer's disease functional assessment and change scale (ADFACS) at baseline and at 6 months. A total of 403 patients finished the study (mild AD = 152; moderate AD = 251). The MMSE total score and M@T score remained stable at 6 months in the whole sample, with MMSE memory domain and M@T free and cued recall domains improving significantly from baseline. Total ADFACS, instrumental (IADL) and basic activities of daily living (BADL) got significantly worse, with the worsening being significantly greater in the moderate AD group. Significant differences between the groups favoring mild AD were observed for MMSE memory, orientation and language domains, M@T temporal orientation and semantic memory domains, and for IADL. We concluded that in AD patients on donepezil, cognition remains stable at 6 months. The beneficial effect of donepezil treatment, in terms of cognition and functionality, is greater for mild than for moderate AD.     

老年性痴呆与血管性痴呆智能障碍的比较研究

本文应用长谷川痴呆评定量表、MMSE及Kohs立方体组合测验,对32例老年性痴呆、74例血管性痴呆及82例非痴呆老人进行了智能测查。结果发现,痴呆组三项测验成绩均显著低于非痴呆老人组。痴呆组成绩比较,同一严重程度的老年性痴呆与血管性痴呆三项测验得分比较均无显著性差异。不同严重程度的痴呆应用MMSE、长谷川痴呆量表的得分比较有显著性差异。轻度痴呆组得分最高,中度组次之,重度痴呆组得分最低。Kohs测验结果发现,轻度痴呆组得分显著低于非痴呆老人组。轻度与中度痴呆组、中度与重度痴呆组比较无显著性差异。这提示Kohs测验仅可作为轻度痴呆的筛查工具,对鉴别痴呆严重程度的临床价值不大。 本文结果还表明,三项测验有较好的正相关。测验成绩与诊断、疾病严重程度、文化程度有密切关系,与性别、年龄、职业、婚姻状况及病程等因素无关。     

Clinical backgrounds and morbidity of cognitive impairment in elderly diabetic patients

Despite numerous reports that have linked diabetes with cognitive impairment (CI), there are few studies that have attempted to clarify the morbidity of CI among elderly diabetic patients. The Mini-Mental State Examination (MMSE) was performed on 240 diabetic patients aged 65 years or older who had no diagnosis of dementia. The MMSE scores were 28-30 (normal range) in 151 patients (63%), 24-27 (suspected CI) in 77 (32%), and ≤ 23 (definite CI) in 12 (5%). Eight of the 12 patients with MMSE scores ≤ 23 underwent further detailed examination: the final diagnosis was Alzheimer's disease (AD) (N = 5), vascular dementia (N = 2), and mixed dementia (N = 1). Among 24 of the 77 patients with MMSE scores of 24-27 who were referred for further detailed examination, the final diagnosis was early AD (N = 5), cerebrovascular disease (CVD) (N = 10), and mild CI (N = 7). Only 2 of the patients were judged as being normal. The percentage of patients with a history of CVD, the rate of diuretic use, and the serum levels of non-high-density lipoprotein cholesterol were higher, and the percentage of patients with a history of habitual alcohol consumption was lower in the low MMSE score group than in the normal MMSE score group. Among elderly diabetic patients aged 65 years or older, 5% had evident CI and 32% had suspected CI. Medical staff involved in the care of diabetic patients should be highly aware of possible CI in this patient population.     

Mini-mental state examination and mental deterioration battery: analysis of the relationship and clinical implications

OBJECTIVES: To explore the associative structure between a screening test for dementia, the Mini-Mental State Examination (MMSE), and a neuropsychological battery for the detection of dementia, the Mental Deterioration Battery (MDB). DESIGN: A retrospective analysis. SETTING: Psychology unit of a general hospital in Rome, Italy. PARTICIPANTS: Three hundred consecutive outpatients and inpatients referred to our hospital on the basis of suspected cognitive impairment and evaluated between January 1999 and March 2000. MEASUREMENTS: MMSE and MDB. RESULTS: Of the 300 subjects evaluated by the MMSE score, 142 (47.3%) were considered to be cognitively healthy, and 116 (38.7%) were mildly and 42 (14.0%) moderately impaired. Factor analysis of MDB extracted three factors able to account for 75% of the total variance: a visuospatial factor, verbal memory ability, and a language skill. Using MMSE as an independent variable, a linear regression model could account for the visuospatial and language factors and a cubic regression model for the verbal memory factor. Within the normal MMSE boundaries (24-30), a dramatic decrease of verbal memory could be documented, whereas the slope is less steep in the mild impairment group (16-23). CONCLUSIONS: Our findings indicate the presence of a warning range within the normal MMSE interval. Thus, the traditional MMSE cutoff values may not be appropriate in detecting early phases of dementia. When patients score about 27 on MMSE, it should be of interest to check whether they fail only on long-term memory tests, because this could be a first signal of a preclinical condition heralding clear dementia (e.g., mild cognitive impairment).     

Intersecting pentagon copying and clock drawing test in mild and moderate Alzheimer's disease

BackgroundIn Alzheimer's disease (AD) drawing and constructional abilities are impaired and worsen as the disease progresses.PurposeTo examine the feasibility of and develop a method for screening, diagnosis, and staging of dementia that can be quickly administered and interpreted in the clinical setting.MethodsThe study aims to describe a scoring mechanism of the intersecting pentagon copying (IPC) task based on the degree of drawing failure and pitted against the Mini-Mental State Examination (MMSE) and the clock drawing test (CDT), which is probably its most likely competitor for a small measure. This is a prospective cohort study of 91 probable dementia patients of the Alzheimer type referred to the geriatrician over a period of 3 years where the suitability of prescribing acetyl cholinesterase inhibitor is investigated. The patients were categorized as follows: 18 (20%) normal, 31 (34%) mild dementia, and 42 (46%) moderate dementia. The copying of the pentagon was part of the MMSE and these drawings were further scrutinized and a 10-point scoring method developed. Each IPC and CDT was blindly and independently rated by two geriatricians.ResultsThe MMSE and Clinical Dementia Rating were found to have very similar staging results. The IPC had some commonality with these measures for patients defined as normal in that most score 10/10 for the IPC. However, both mild and moderate dementia patients according to other measures have an overlapping range of scores on the IPC scoring method developed. The highest association for the IPC with the CDT was 0.68. IPC had a stronger correlation with the total MMSE than with the two shorter versions.ConclusionThe IPC seems to operate more as a screening tool rather than a dementia staging instrument and assists in identifying normal patients.     

规律体育锻炼干预老年轻度认知功能障碍的临床研究

目的观察规律体育锻炼对老年轻度认知功能障碍（MCI）患者的认知功能及生活质量影响。方法收集社区中有记忆减退主诉的老年人群,将诊断为退行性MCI（NMCI）及血管性MCI（VMCI）患者共163例纳入研究。各自按照有无体育锻炼意愿分为干预组和对照组,对干预组实施规律的体育锻炼督促、指导。应用神经心理学量表及生活质量评定表进行评估。结果两组病例的干预组干预前后比较：MMSE、AVMT5、ADL、SF-36、TMT、CFT、QUALITY的评分有统计学意义（渐进显著性〈0．01）。结论规律体育锻炼能有效改善MCI患者的认知功能及生活质量。     

Depression associated with dementia

Depression and cognitive disorders, including dementia and mild cognitive impairment, are common disorders in old age. Depression is frequent in dementia, causing distress, reducing the quality of life, exacerbating cognitive and functional impairment and increasing caregiver stress. Even mild levels of depression can significantly add to the functional impairment of dementia patients and the severity of psychopathological and neurological impairments increases with increasing severity of depression. Depressive symptoms may be both a risk factor for, as well as a prodrome of dementia. Major depressive syndrome of Alzheimer’s disease may be among the most common mood disorders of older adults. Treating depression is therefore a key clinical priority to improve the quality of life both of people with dementia as well as their carergivers. Nonpharmacological approaches and watchful waiting should be attempted first in patients who present with mild to moderate depression and dementia. In cases of severe depression or depression not able to be managed through nonpharmacological means, antidepressant therapy should be considered.     

Effects of errorless and errorful face-name associative learning in moderate to severe dementia

BACKGROUND AND AIMS: The prevention of errors during learning has been found to be effective in overcoming memory problems in patients with amnesia compared with errorful or trial-and-error learning, possibly as a result of intact implicit memory function. Although errorless learning is a clinically promising technique used in cognitive training settings, to date only a few studies have examined errorless learning in patients with dementia. METHODS: The current study examined errorless and errorful learning using a face-name associative memory task in a group of moderate to severe dementia patients suffering from probable Alzheimer's disease (MMSE < or = 22; n = 10) using a fully counterbalanced within-subject design. RESULTS: Errorless learning had a significantly beneficial effect after two consecutive learning trials (p = 0.01). However, after an unfilled delay of 10 minutes, no significant differences in memory performance were found between errorless and errorful learning. Furthermore, current effects were much smaller compared with previous findings in healthy adults and early-stage dementia patients. CONCLUSIONS: Although errorful learning resulted in better performance in a face-name associative memory task in patients with dementia, this effect was only short-lived. Thus, the beneficial effects of errorless learning are probably not due to intact implicit memory function, but may also be subserved by explicit memory, a memory system that is typically impaired in dementia. Also, the clinical applicability of errorless learning in teaching patients with moderate to severe dementia face-name associations is limited.     

Diagnosing cognitive impairment and dementia in primary health care -- a more active approach is needed

OBJECTIVE: to determine the documentation rate of dementia in primary health care, the clinical characteristics of patients with documented and undocumented dementia, and the diagnostic evaluations made in cognitive impairment. DESIGN: cross-sectional population-based study with a retrospective review of medical history. SETTING: primary health care in the municipality of Lieto, Southwestern Finland. SUBJECTS: all the inhabitants aged 64 and over in Lieto. Participation rate 82%, numbers = 1260. MEASUREMENTS: assessment of dementia according to DSM-IV criteria, and severity according to Clinical Dementia Rating. Possible documentation of dementia and evaluations done were reviewed from primary health care medical records. RESULTS: 112 patients with dementia were found. The sensitivity of the general practitioners' judgment of dementia was 48.2% and the specificity 99.6%. The documentation rate of dementia was 73% in severe, 46% in moderate and 33% in mild dementia. A greater proportion of the patients with undocumented dementia were male (P = 0.003), lived at home (P = 0.003), coped better with the instrumental activities of daily living (P = 0.006), had more depression (P = 0.029) and milder dementia (P = 0.005) than patients with documented dementia. Thyroid stimulating hormone was measured in 51% of the patients with suspected memory impairment or dementia, B12 vitamin in 20%, and serum calcium in 18%. Twenty-eight per cent of the patients had been tested for cognitive function, 68% for depressive symptoms, and 88% for social abilities. Forty-two per cent of patients were referred to a specialist, 32% of patients who were over 75 years. CONCLUSIONS: less than half of the patients with dementia had their diagnosis documented in primary care medical records. Documentation increased in more advanced dementia. The diagnostic evaluations for reversible causes of dementia were insufficient in primary care, and they were done at a late phase of cognitive impairment.     

Deficits in controlled processing may predict dementia: a twin study.

This study tested for differential patterns of cognitive decline in 33 twin pairs for which both were nondemented, but 1 member of the pair went on to develop dementia. Compared with their nondemented twin partners, twins who later developed dementia already showed poorer performance on tests of memory and attention, visuospatial-reasoning skills, and perceptual speed and the Mini-Mental State Examination (MMSE). The authors suggest that this cluster of tests reflects deficits in controlled rather than automatic cognitive processes. Nondemented twin partners of the twins who became demented were also compared with 33 matched controls selected from pairs in which both members remained nondemented. Nondemented twin partners scored lower than matched controls on tests of verbal ability, memory and attention, and perceptual speed and the MMSE. This finding indicates that nondemented twin partners of demented twins are at elevated risk themselves for becoming demented, and further suggests that certain areas of cognition are compromised prior to diagnosis of dementia.     

Alzheimer patient evaluation and the mini-mental state: item characteristic curve analysis

To develop a tool for precisely assessing dementia severity, items should be selected according to their relationship to the overall progression of the disease. Using an item characteristic curve analysis (ICC), items were examined from the Folstein Mini-Mental State Exam (MMSE), a useful clinical tool for evaluating dementia. MMSE data were available for 86 patients who met DSM-III criteria for primary degenerative dementia -- possible or probable Alzheimer's disease (AD). A logistic regression analysis of the probability of correct performance on an item, given the total MMSE score, yielded statistics for difficulty and discrimination. These statistics were interpreted respectively as indicators of the point in the progression of the illness at which the mental function tested by that item is lost and the rapidity of that loss. The data indicated a systematic progression of the development of symptoms in AD related to decline of memory function. Temporal orientation was lost before spatial and object orientation, and recollection of words was lost before ability to repeat them. ICC can help to delineate the loss of mental functions during the course of AD.     

阿尔茨海默病不同严重程度时的神经心理学研究

目的 研究阿尔茨海默病（ＡＤ）不同痴呆严重程度时的神经心理模式特点。方法 使用多种神经心理测验测试了符合国际公认的痴呆诊断标准（ＮＩＮＣＤＳ－ＡＤＲＤＡ）“很可能为ＡＤ”的患者,使用临床痴呆评定（ＣＤＲ）确定痴呆严重程度。结果 ＡＤ早期即出现视空间功能障碍,中、重度阶段均明显衰退。认知功能障碍也始于ＡＤ早期,中、重度阶段呈持续性显著衰退趋势,记忆功能在ＡＤ早期即出现大幅度衰退,,中期衰退幅度不大,     

门诊痴呆患者诊断率低的原因分析

目的 了解我院神经内科门诊痴呆患者就诊情况,分析影响痴呆患者就诊的因素.方法 对2009年9月15日至2009年12月25日在西安交通大学医学院第一附属医院神经内科门诊就诊的患者中符合入选标准者,采用“三步法”筛查痴呆,并根据美国精神疾病诊断和统计手册第4版(修订版)(DSM-Ⅳ-TR)的标准诊断痴呆及其亚型、美国国立神经疾病研究院语言交流障碍-脑卒中-老年性痴呆及相关疾病协会(NINCDS-ADRDA)标准诊断阿尔茨海默病,美国国立神经疾病和脑卒中研究所和瑞士国际神经科学研究协会(NINDS-AIREN)标准诊断血管性痴呆.对临床确诊的痴呆患者的照料者进行面对面问卷调查,了解痴呆患者就诊情况.结果 调查期间共有门诊患者8042例次,完成IQCODE检查1716例,MMSE检查317例,成套神经心理测查72例,诊断痴呆41例,55岁以上门诊患者痴呆患病率1.8％.其中阿尔茨海默病23例(56.1％),血管性痴呆12例(29.3％),混合性痴呆2例(4.9％),其他原因痴呆4例(9.7％,分别为路易小体痴呆、乙型脑炎后痴呆、癫痫后痴呆和不明原因痴呆各1例);轻度痴呆18例(43.9％),中度痴呆19例(46.3％),重度痴呆4例(9.8％);既往确诊痴呆4例(9.8％),门诊医生诊断痴呆15例(36.5％),门诊医生未诊断痴呆而调查时发现痴呆22例(53.7％).完成照料者问卷35份,其中照料者对痴呆完全不了解10例(28.6％),稍有了解22例(62.8％),了解较多3例(8.6％).本次因记忆减退等认知功能障碍症状来就诊19例(46.3％),而以其他非认知功能障碍症状来就诊22例(53.7％),包括性格改变、精神症状、脑梗死、疲乏、睡眠紊乱、震颤及其他症状等.痴呆患者未及时就诊的原因包括:照料者认为老年人的认知功能障碍症状是自然衰老19例(54.3％),患者本人不愿就诊5例(14.3％),认为痴呆无法治疗2例(5.7％),经济困难1例(2.9％),就诊不便3例(8.5％),其他原因5例(14.3％).结论 我国痴呆患者就诊率低,其主要原因是照料者对痴呆认识不足,也与门诊医生仅关注患者的躯体症状,而忽略认知功能症状有关.