随着人口老龄化进程加剧，近年来我国痴呆患者数量呈现快速增多趋势，但目前我国痴呆诊治相关医疗资源主要集中在大型综合医院，远不能满足广大痴呆患者需求。目前仍存在基层医务工作者由于缺乏痴呆识别和诊治经验、不能区分痴呆与正常老化而导致多数痴呆患者得不到及时救治，进而贻误病情、导致患者错过早期治疗的最佳时间等问题。提高广大基层医务工作者对痴呆的识别和诊治能力、建立基层医务工作者与三甲医院记忆门诊的上下联动机制并进行连续性管理是中国痴呆防控的必要措施。本文主要就我国痴呆流行病学特征、诊治现状及困境、提高痴呆规范化管理水平的有效改进措施等进行了分析。

Under the U.S. national Alzheimer's plan, the National Institutes of Health identified milestones required to meet the plan's biomedical research goal (Goal 1). However, similar milestones have not been created for the goals on care (Goal 2) and support (Goal 3).The Alzheimer's Association convened a workgroup with expertise in clinical care, long-term services and supports, dementia care and support research, and public policy. The workgroup reviewed the literature on Alzheimer's care and support; reviewed how other countries are addressing the issue; and identified public policies needed over the next 10 years to achieve a more ideal care and support system.The workgroup developed and recommended 73 milestones for Goal 2 and 56 milestones for Goal 3.To advance the implementation of the U.S. national Alzheimer's plan, the U.S. government should adopt these recommended milestones, or develop similar milestones, to be incorporated into the national plan.Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

为应对老年痴呆患者数量的不断增长给家庭和社会带来沉重的经济以及照护负担，为相关专业人员提供针对性的规范和指导性文件，我们在参考国内外相关临床指南、系统综述及原创研究的基础上，结合国内相关领域临床及护理专家的实践经验，针对痴呆患者基于社区支持的居家照护人员要求及设施、照护的具体内容、照护的卫生资源及政策支持，居家到机构的过渡照护等方面提出了专业建议，为规范基于社区支持的老年痴呆患者居家照护提供指导和实践支持。

Background: The principal aim of this study was to demonstrate the gender-specific cognitive patterns among middle-aged and elderly Chinese adults, investigate the risk factors on global and domain-specific cognitive performance in men and women, respectively, and report demographically adjusted norms for cognitive tests.Methods: The Effects and Mechanism of Cholesterol and Oxysterol on Alzheimer's disease (EMCOA) study enrolled 4573 participants aged 50-70 years in three Chinese cities. All participants underwent an extensive neuropsychological test battery. Composite scores for specific domains were derived from principal component analysis (PCA). Multivariate linear regression models were used to determine gender-specific risk factors and demographically adjusted normative data.Results: Three cognitive domains of verbal memory, attention/processing speed/executive function, and cognitive flexibility were extracted. A female advantage in verbal memory was observed regardless of age, whereas men tended to outperform women in global cognition and attention/processing speed/executive function. The effects of education on women were more substantial than men for general cognition and attention/processing speed/executive function. For all the cognitive tests, regression-based and demographically adjusted normative data were calculated.Conclusions: There is a need for gender-specific intervention strategies for operationalizing cognitive impairment.