The primary care physician and Alzheimer’s disease: An international position paper

• Published in: The Journal of nutrition, health & aging Vol. 14; no. 2; pp. 110 - 120
• Main Authors: Villars, H., Oustric, S., Andrieu, S., Baeyens, J. P., Bernabei, R., Brodaty, H., Brummel-Smith, K., Celafu, C., Chappell, N., Fitten, J., Frisoni, G., Froelich, L., Guerin, O., Gold, G., Holmerova, I., Iliffe, S., Lukas, A., Melis, R., Morley, J. E., Nies, H., Nourhashemi, F., Petermans, J., Ribera Casado, J., Rubenstein, L., Salva, A., Sieber, C., Sinclair, A., Schindler, R., Stephan, E., Wong, R. Y., Vellas, B.
• Format: Journal Article Conference Proceeding Web Resource
• Language: English
• Published: Paris Springer-Verlag 01.02.2010; Springer; Springer Nature B.V; Serdi Edition
• Subjects: Adult and adolescent clinical studies; Aging; Alzheimer Disease - diagnosis; Alzheimer Disease - therapy; Alzheimer Disease/diagnosis/therapy; Biological and medical sciences; Clinical Competence; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Early Diagnosis; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Geriatrics; Geriatrics/Gerontology; Gériatrie; Health Services for the Aged - standards; Human health sciences; Humans; Interdisciplinary Communication; Medical sciences; Medicine; Medicine & Public Health; Neurology; Neurosciences; Nutrition; Organic mental disorders. Neuropsychology; Patient Care Management; Patient Care Team; Physician's Role; Primary Care Medicine; Primary Health Care - standards; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Quality of Health Care; Quality of Life Research; Sciences de la santé humaine; Societies; Vertebrates: anatomy and physiology, studies on body, several organs or systems; follow-up; diagnosis; clinical trials; primary care physician; Dementia; care; Nervous system diseases; Alzheimer disease; Health staff; Position; Primary health care; Physician; Metabolic diseases; Cerebral disorder; Central nervous system disease; Clinical trial; Paper; Degenerative disease; Diagnosis
• ISSN: 1279-7707; 1760-4788; 1760-4788
• DOI: 10.1007/s12603-010-0022-0

This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer’s disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a literature review and expert’s opinions who met in Paris, France, on July 2009 during the International Association of Geriatrics and Gerontology (IAGG) World Congress. The PCP’s intervention appears essential at many levels: detection of the onset of dementia, diagnostic management, treatment and follow-up. The key role of the PCP in the management of AD, as care providers and care planners, is consolidated by the family caregiver’s confidence in their skills. In primary care practice the first step is to identify dementia. The group proposes a “case finding” strategy, in target situations in which dementia should be detected to allow, secondarily, a diagnosis of AD, in certain cases. We propose that the PCP identifies ‘typical’ cases. In typical cases, among older subjects, the diagnosis of “probable AD” can be done by the PCP and then confirm by the specialist. While under-diagnosis of AD exists, so does under-disclosure. Disclosure to patient and family should be done by both specialist and PCP. Then, the PCP has a central role in management of the disease with the general objectives to detect, prevent and treat, when possible, the complications of the disease (falls, malnutrition, behavioural and psychological symptoms of dementia). The PCP needs to give basic information to the caregiver on respite care and home support services in order to prevent crisis situations such as unplanned institutionalisation and “emergency” hospital admission. Finally, therapeutic research must be integrated in the daily practice of PCP. It is a matter of patients’ right to benefit from access to innovation and clinical research whatever his age or diseases, while of course fully respecting the rules and protective measures that are in force.