失智症诊断后管理相关指南的质量评价与内容分析
Quality Evaluation and Content Analysis of Guidelines Related to Post-diagnosis Management of Dementia
李海瑾 1朱宸立 1李卉 1冯郑文 1乔雨晨 2杜娟1
作者信息
- 1. 100069 北京市丰台区，首都医科大学全科医学与继续教育学院
- 2. 100053 北京市西城区，首都医科大学宣武医院神经内科
- 折叠
摘要
背景 失智症患病率不断上升，而专业医疗资源相对匮乏，失智症相关健康服务应越来越多地由基层医疗机构提供。目前我国尚缺少针对社区的失智症管理指南，失智症诊断后管理服务缺乏规范指导。目的 采用指南研究和评估工具Ⅱ（AGREE Ⅱ）对国内外失智症诊断后管理相关指南进行评价，并对相关推荐意见进行分析汇总，以期为失智症诊断后管理工作提供参考。方法 系统检索PubMed、Medline、Elsevier、中国知网（CNKI）、万方数据知识服务平台、中华医学期刊全文数据库（Yiigle）等常用中英文数据库，以及 google scholar 网站、国际指南协作网（GIN）、英国国家临床示范研究所网站（NICE）、新西兰临床实践指南网站（NZGG）、加拿大临床实践指南网站（CMA Infobase）和苏格兰校际指南网站（SIGN），获取近10年发表的失智症诊断后社区管理相关指南，检索日期截止至2024年10月。使用AGREE Ⅱ工具进行质量评价，并对推荐等级为A和B的指南推荐意见进行分析汇总。结果 最后纳入研究的指南为18篇，其中中国3篇、英国5篇、美国2篇、加拿大2篇、欧洲2篇，日本、澳大利亚、马来西亚、印度各1篇。根据AGREE Ⅱ对指南进行质量评价，结果显示，仅有2篇推荐等级为A级，10篇推荐等级为B级，其余6篇推荐等级为C级，2名研究者对指南评价结果的ICC值均>0.75（P<0.001）。在AGREE Ⅱ领域得分方面，国内指南的范围与目的得分低于国外（P<0.05）。对12篇推荐等级为A、B级的指南推荐意见进行分析汇总，共提取出6个主题：一般原则、定期评估、药物管理、非药物管理、共病管理和照顾者支持。结论 现有失智症诊断后管理相关指南在方法学质量上仍有待提升，且部分推荐意见的本土适用性不足。我国学者应严格遵循指南构建的科学性与规范性原则，尽快构建本土化的失智症诊断后管理指南，更好地指导临床实践。
Abstract
Background With the rising prevalence of dementia and the relative shortage of professional medical resources, dementia-related health services should be increasingly provided by primary care institutions. Currently, China lacks community-based guidelines for dementia management, and post-diagnosis care lacks standardized guidance. Objective This study aims to evaluate domestic and international guidelines on post-diagnosis management of dementia using the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE ), to analyze and summarize their recommendations, and to provide a reference for clinical practice. Methods A systematic search was conducted across major Chinese and English databases, including PubMed, Medline, Elsevier, CNKI, Wanfang Data and Yiigle, as well as websites such as Google Scholar, the Guidelines International Network (GIN), the National Institute for Health and Care Excellence (NICE), the New Zealand Guidelines Group (NZGG), the CMA Infobase, and the Scottish Intercollegiate Guidelines Network (SIGN), to identify guidelines related to community-based post-diagnosis management of dementia published in the past decade. The search was conducted up to October 2024. The AGREE instrument was used for quality assessment, and recommendations from guidelines graded as A and B were analyzed and summarized. Results Eighteen guidelines were included in the study, comprising three from China, five from the United Kingdom, two from the United States, two from Canada, two from Europe, and one each from Japan, Australia, Malaysia, and India. According to the AGREE evaluation, only two guidelines were rated as Grade A, 10 as Grade B, and the remaining six as Grade C. The intraclass correlation coefficient (ICC) values between two researchers were all >0.75 (P<0.001). In terms of AGREE domain scores, Chinese guidelines scored lower than international guidelines in the "Scope and Purpose" domain (P<0.05). Recommendations from the 12 Grade A and B guidelines were synthesized and categorized into six themes: general principles, regular assessment, pharmacological management, non-pharmacological management, comorbidity management, and caregiver support. Conclusion The methodological quality of existing guidelines on post-diagnosis management of dementia requires improvement, and some recommendations lack applicability to the local context. Chinese scholars should strictly adhere to the scientific and normative principles of guideline development and promptly establish a localized post-diagnosis management guideline of dementia to better guide clinical practice.关键词
失智症/阿尔茨海默病/社区管理/指南/质量评价/指南研究和评估工具Ⅱ引用本文复制引用
李海瑾,朱宸立,李卉,冯郑文,乔雨晨,杜娟.失智症诊断后管理相关指南的质量评价与内容分析[EB/OL].(2026-02-12)[2026-02-15].https://chinaxiv.org/abs/202602.00164.学科分类
临床医学/医学研究方法/神经病学、精神病学
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