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期刊来源：Nat Med

原文链接：https://doi.org/10.1038/s41591-024-03012-8

摘要内容如下：

痴呆在初级保健中经常得不到诊断，即使诊断出来，也得不到治疗。5-Cog范式是一种简单的、文化上熟练的认知检测工具，与临床决策支持相结合，可以减少改善痴呆诊断和护理的障碍。我们在经历健康差异（种族/少数民族和社会经济弱势群体）的初级保健患者中进行了一项随机对照试验。有认知问题的老年人以1:1的比例被分配到5-COG范式或对照。主要结果是改善痴呆护理行动，定义为90天内的以下任何终点：新的轻度认知障碍综合征或痴呆诊断以及针对认知适应症的调查、药物治疗或专家转诊。使用意向性治疗原则和多变量Logistic回归对各组进行比较。总体而言，1，201名患者（平均年龄72.8岁，72%为女性，94%为黑人、西班牙裔或拉丁裔）入选，599名患者被分配到5-COG组，602名患者被分配到对照组。与对照组相比，5-COG范式显示痴呆护理行动改善的几率是对照组的三倍（比值比3.43，95%置信区间2.32-5.07）。未报告严重的干预相关不良事件。5-COG范式改善了认知问题患者的诊断和管理，并为促进实践改变以改善初级保健中的痴呆护理行动提供了证据。

英文原文如下：

Abstracts

Dementia is often undiagnosed in primary care, and even when diagnosed, untreated. The 5-Cog paradigm, a brief, culturally adept, cognitive detection tool paired with a clinical decision support may reduce barriers to improving dementia diagnosis and care. We performed a randomized controlled trial in primary care patients experiencing health disparities (racial/ethnic minorities and socioeconomically disadvantaged). Older adults with cognitive concerns were assigned in a 1:1 ratio to the 5-Cog paradigm or control. Primary outcome was improved dementia care actions defined as any of the following endpoints within 90 days: new mild cognitive impairment syndrome or dementia diagnoses as well as investigations, medications or specialist referrals ordered for cognitive indications. Groups were compared using intention-to-treat principles with multivariable logistic regression. Overall, 1,201 patients (mean age 72.8 years, 72% women and 94% Black, Hispanic or Latino) were enrolled and 599 were assigned to 5-Cog and 602 to the control. The 5-Cog paradigm demonstrated threefold odds of improvement in dementia care actions over control (odds ratio 3.43, 95% confidence interval 2.32-5.07). No serious intervention-related adverse events were reported. The 5-Cog paradigm improved diagnosis and management in patients with cognitive concerns and provides evidence to promote practice change to improve dementia care actions in primary care.ClinicalTrials.gov: NCT03816644 .

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