RACGP《全科医学的预防活动指南》解读与讨论:阿尔茨海默病

摘要： 阿尔茨海默病等认知障碍疾病起病隐匿、病程漫长，早期识别是降低疾病负担的关键环节。澳大利亚全科医生学会（RACGP）发布的《全科医学的预防活动指南（第10版）》（以下简称"红皮书"）以基层实践为导向，提出以机会性识别为核心、聚焦高风险人群的认知障碍早期识别与干预策略，系统整合了筛查原则、筛查工具选择及多维度可干预危险因素管理，在强调循证性的同时突出了全科医生连续照护与全生命周期管理的优势。本文结合Lancet 2024年痴呆防控报告、WHO相关证据及"全生命周期管理"理念，对"红皮书"中认知障碍预防与识别的关键要点进行系统解读，从全科医生视角梳理高危人群识别、病理性排除、筛查工具分层应用及长期干预路径。分析认为，蒙特利尔认知评估量表（MoCA）、全科医学认知筛查工具（GPCOG）、跨文化痴呆症评估量表（RUDAS）、阿尔茨海默病8项问卷（AD8）等工具在不同社区人群与服务场景中具有互补优势，适合嵌入基层机会性识别流程；运动、代谢管理、听力干预、睡眠管理及多重用药优化等措施构成可操作的全生命周期干预组合。结合我国基层实践现状，当前认知障碍早期识别仍面临筛查与转诊衔接不足、人员培训与资源整合有限及公众认知不足等问题。本文据此提出，将认知筛查嵌入家庭医生签约服务与慢性病管理流程，依托紧密型医疗集团构建"筛查—评估—转诊—干预—随访"闭环路径，有助于推动认知障碍防控关口前移，为我国基层认知健康管理提供可借鉴的实践思路。

关键词: 阿尔茨海默病, 痴呆（失智症）, 全科医生, 早期识别, 认知障碍, 初级卫生保健

Abstract:

Alzheimer's disease and related cognitive disorders are characterized by an insidious onset and long disease course, making early identification a critical strategy for reducing disease burden. The 10th edition of the Guidelines for Preventive Activities in General Practice issued by the Royal Australian College of General Practitioners (RACGP) adopts a strong primary care orientation and emphasizes opportunistic case-finding among high-risk populations, integrating evidence-based principles on screening, selection of cognitive assessment tools, and multidimensional management of modifiable risk factors. Drawing on the 2024 Lancet Commission on Dementia Prevention, Intervention and Care, World Health Organization evidence, and the life-course management framework, this paper systematically interprets the key recommendations of the RACGP guideline from a general practice perspective, with a focus on risk identification, exclusion of reversible causes, stratified use of screening instruments, and longitudinal management. The analysis suggests that commonly used tools such as the MoCA, GPCOG, RUDAS and AD8 demonstrate complementary strengths across different community populations and clinical contexts, supporting their integration into opportunistic screening pathways in primary care. In addition, interventions targeting physical activity, metabolic control, hearing impairment, sleep disorders and medication optimization constitute a feasible life-course prevention package. In the Chinese primary care context, early identification of cognitive impairment remains constrained by insufficient linkage between screening and referral, limited workforce training and resource integration, and low public awareness. This paper proposes embedding cognitive screening into family doctor contract services and chronic disease management programmes, and leveraging integrated care networks to establish a closed-loop pathway encompassing screening, assessment, referral, intervention and follow-up, thereby advancing earlier prevention and strengthening the role of primary care in dementia risk reduction.

Key words: Alzheimer's disease, Dementia, General practitioners, Early identification, Cognitive impairment, Primary health care

引用本文

黄文静,邱珊娇,陈章,等. RACGP《全科医学的预防活动指南》解读与讨论：阿尔茨海默病早期识别路径与基层实践[J]. 中国全科医学, 2026, 29(07): 823-829.