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The journal of nutrition, health & aging

, Volume 14, Issue 2, pp 110–120 | Cite as

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

  • H. Villars
  • S. Oustric
  • S. Andrieu
  • J. P. Baeyens
  • R. Bernabei
  • H. Brodaty
  • K. Brummel-Smith
  • C. Celafu
  • N. Chappell
  • J. Fitten
  • G. Frisoni
  • L. Froelich
  • O. Guerin
  • G. Gold
  • I. Holmerova
  • S. Iliffe
  • A. Lukas
  • R. Melis
  • J. E. Morley
  • H. Nies
  • F. Nourhashemi
  • J. Petermans
  • J. Ribera Casado
  • L. Rubenstein
  • A. Salva
  • C. Sieber
  • A. Sinclair
  • R. Schindler
  • E. Stephan
  • R. Y. Wong
  • B. Vellas
Article

Abstract

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.

Key words

Dementia primary care physician diagnosis care follow-up clinical trials 

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Copyright information

© Serdi and Springer Verlag France 2010

Authors and Affiliations

  • H. Villars
    • 1
    • 30
  • S. Oustric
    • 2
  • S. Andrieu
    • 3
  • J. P. Baeyens
    • 4
  • R. Bernabei
    • 5
  • H. Brodaty
    • 6
  • K. Brummel-Smith
    • 7
  • C. Celafu
    • 8
  • N. Chappell
    • 9
  • J. Fitten
    • 10
  • G. Frisoni
    • 11
  • L. Froelich
    • 12
  • O. Guerin
    • 13
  • G. Gold
    • 14
  • I. Holmerova
    • 15
  • S. Iliffe
    • 16
  • A. Lukas
    • 17
  • R. Melis
    • 18
  • J. E. Morley
    • 19
  • H. Nies
    • 20
  • F. Nourhashemi
    • 1
    • 3
  • J. Petermans
    • 21
  • J. Ribera Casado
    • 22
  • L. Rubenstein
    • 23
  • A. Salva
    • 24
  • C. Sieber
    • 25
  • A. Sinclair
    • 26
  • R. Schindler
    • 27
  • E. Stephan
    • 28
  • R. Y. Wong
    • 29
  • B. Vellas
    • 1
    • 3
  1. 1.Gérontopôle, Alzheimer’s Disease Research and Clinical CenterToulouse University HospitalToulouseFrance
  2. 2.Department of family medicineToulouse University HospitalToulouseFrance
  3. 3.Inserm U558ToulouseFrance
  4. 4.Generaal JungbluthlaanOostendeBelgium
  5. 5.Instituto de medecine Interna e Geriatria Universita Cattalica del Sacre Cuore Largo A GemelliROMEItaly
  6. 6.Dementia Collaborative Research CenterUniversity Of New South WalesCoogeeAustralia
  7. 7.Department of Geriatrics Florida StateUniversity College of MedicineTallahasseeUSA
  8. 8.Section of Geriatrics, Dept of MedicineLSUHSC, New Orleans, La. at LSU Health Sciences CenterNew OrleansUSA
  9. 9.Center on AgingUniversity of VictoriaSTN CSC VictoriaCanada
  10. 10.DVAMC 116A-9SEPULVEDAUSA
  11. 11.IRCCS San Giovanni di Rio, FBFBresciaItaly
  12. 12.Central Institute for Mental HealthMannheimGermany
  13. 13.University of Nice Sophia AntipolisNiceFrance
  14. 14.Service de Médecine Interne de Réhabilitation Hôpital des Trois chênesDpt de Réhabilitation et Gériatrie 3Thonex, GenevaSwitzerland
  15. 15.Center of Gerontology SimunkovaPrahaCzech republic
  16. 16.Dept. of Primary Care Population SciencesUniversity College LondonLondonUK
  17. 17.Bethesda Geriatric HospitalGeriatric Center UlmUlmGermany
  18. 18.Department of Geriatric MedicineUniversity Hospital NijmegenHB NijmegenThe Netherlands
  19. 19.Division of geriatrics St Louis University Medical SchoolST LOUISUSA
  20. 20.Vilans Center of Expertise for Long-term CareUtrechtThe Netherlands
  21. 21.Centre Hospitalo-Universitaire Service de Gériatrie Domaine du Sar TilmanLiègeBelgium
  22. 22.Clínico San Carlos C/. Profesor Martín LagosMadridSpain
  23. 23.Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesUSA
  24. 24.Institut Català de l’EnvellimentUniversitat Autònoma de BarcelonaBarcelonaSpain
  25. 25.Chefarzt Medizinische Klinik 2 Klinikum Nurnberg Nord Prof.NurnbergGermany
  26. 26.University of Luton PutteridgeBEDFORDSHIREUK
  27. 27.Clinical Disease Area Expert Alzheimer’s Disease. PfizerNew YorkUSA
  28. 28.Department of Internal Medicine HospitalSt Georges BeyrouthLebanon
  29. 29.Department of MedicineUniversity of British ColumbiaVancouver, British ColumbiaCanada
  30. 30.Gerontopole, Alzheimer’s Disease Research and Clinical Center; Department of Internal Medicine and Clinical GerontologyUniversity Hospital, Purpan-CasselarditToulouseFrance

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