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

  • Published:
The journal of nutrition, health & aging

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.

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Authors and Affiliations

  1. Gérontopôle, Alzheimer’s Disease Research and Clinical Center, Toulouse University Hospital, Toulouse, France

    H. Villars, F. Nourhashemi & B. Vellas

  2. Department of family medicine, Toulouse University Hospital, Toulouse, France

    S. Oustric

  3. Inserm U558, F-31073, Toulouse, France

    S. Andrieu, F. Nourhashemi & B. Vellas

  4. Generaal Jungbluthlaan, 11 B-8400, Oostende, Belgium

    J. P. Baeyens

  5. Instituto de medecine Interna e Geriatria Universita Cattalica del Sacre Cuore Largo A Gemelli, 800168, ROME, Italy

    R. Bernabei

  6. Dementia Collaborative Research Center, University Of New South Wales, 45 Beach Street, Coogee, NSW, 2034, Australia

    H. Brodaty

  7. Department of Geriatrics Florida State, University College of Medicine, 1115 West Call St, Suite 3140-D, Tallahassee, FL, 32306-4300, USA

    K. Brummel-Smith

  8. Section of Geriatrics, Dept of Medicine, LSUHSC, New Orleans, La. at LSU Health Sciences Center, New Orleans, USA

    C. Celafu

  9. Center on Aging, University of Victoria, PO Box 1700, STN CSC Victoria, BC, V8W 2Y2, Canada

    N. Chappell

  10. DVAMC 116A-9, 16111 Plummer street, SEPULVEDA, CA, 91343, USA

    J. Fitten

  11. IRCCS San Giovanni di Rio, FBF, Via Pilastroni 4, 25125, Brescia, Italy

    G. Frisoni

  12. Central Institute for Mental Health, J5 68072, Mannheim, Germany

    L. Froelich

  13. University of Nice Sophia Antipolis, Gerontology 430 Avenue Pessicart, 06100, Nice, France

    O. Guerin

  14. Service de Médecine Interne de Réhabilitation Hôpital des Trois chênes, Dpt de Réhabilitation et Gériatrie 3, Chemin du Pont Bochet 1226, Thonex, Geneva, Switzerland

    G. Gold

  15. Center of Gerontology Simunkova, 1600, 18200, Praha, Czech republic

    I. Holmerova

  16. Dept. of Primary Care Population Sciences, University College London, Hampstead Campus, Rowland Hill St., London, NW3 2PF, UK

    S. Iliffe

  17. Bethesda Geriatric Hospital, Geriatric Center Ulm, Zollernring 26, 89073, Ulm, Germany

    A. Lukas

  18. Department of Geriatric Medicine, University Hospital Nijmegen, Po Box 9101, 6500, HB Nijmegen, The Netherlands

    R. Melis

  19. Division of geriatrics St Louis University Medical School, 1402 South Grand Blvd, ST LOUIS, MO, 63104, USA

    J. E. Morley

  20. Vilans Center of Expertise for Long-term Care, P.O Box 8228, Utrecht, 3503 RE, The Netherlands

    H. Nies

  21. Centre Hospitalo-Universitaire Service de Gériatrie Domaine du Sar Tilman, 4020, Liège, Belgium

    J. Petermans

  22. Clínico San Carlos C/. Profesor Martín Lagos, s/n — planta Baja, 28040, Madrid, Spain

    J. Ribera Casado

  23. Department of Medicine, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, Los Angeles, CA, 90095, USA

    L. Rubenstein

  24. Institut Català de l’Envelliment, Universitat Autònoma de Barcelona, Sant Antoni Ma Claret 171, 08041, Barcelona, Spain

    A. Salva

  25. Chefarzt Medizinische Klinik 2 Klinikum Nurnberg Nord Prof., Ernst-Nathan Strasse 1, 9041, Nurnberg, Germany

    C. Sieber

  26. University of Luton Putteridge, Bury Campus Hitchin Road LUTON, BEDFORDSHIRE, LU2 8LE, UK

    A. Sinclair

  27. Clinical Disease Area Expert Alzheimer’s Disease. Pfizer, Inc 235 East 42nd Street Mailstop 235/9/37, New York, NY, 10017, USA

    R. Schindler

  28. Department of Internal Medicine Hospital, St Georges Beyrouth, Lebanon

    E. Stephan

  29. Department of Medicine, University of British Columbia, 7153 - 2775, Laurel Street, Vancouver, British Columbia, Canada

    R. Y. Wong

  30. Gerontopole, Alzheimer’s Disease Research and Clinical Center; Department of Internal Medicine and Clinical Gerontology, University Hospital, Purpan-Casselardit, 170 Avenue de Casselardit, 31059, Toulouse, France

    H. Villars

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  1. H. Villars
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  2. S. Oustric
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  14. G. Gold
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  21. F. Nourhashemi
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  24. L. Rubenstein
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  25. A. Salva
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  26. C. Sieber
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  27. A. Sinclair
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  28. R. Schindler
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  29. E. Stephan
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  30. R. Y. Wong
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  31. B. Vellas
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Correspondence to H. Villars.

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Villars, H., Oustric, S., Andrieu, S. et al. The primary care physician and Alzheimer’s disease: An international position paper. J Nutr Health Aging 14, 110–120 (2010). https://doi.org/10.1007/s12603-010-0022-0

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  • DOI: https://doi.org/10.1007/s12603-010-0022-0

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