Packages of Care for Dementia in Low- and Middle-Income Countries 英文参考文献.docVIP

NeglectedDiseases 1 PackagesofCareforDementiainLow-andMiddle- IncomeCountries MartinJ.Prince1*,DaisyAcosta2,EricoCastro-Costa1,3,JimJackson4,K.S.Shaji5 1HealthServiceandPopulationResearchDepartment,InstituteofPsychiatry,King’sCollegeLondon,London,UnitedKingdom,2UniversidadNacionalPedroHenriquez Uren?a(UNPHU),SantoDomingo,DominicanRepublic,3CentrodePesquisaReneRachou/Fiocruz,BeloHorizonte,MinosGerais,Brazil,4AlzheimerScotland,Edinburgh, UnitedKingdom,5MedicalCollege,Thrissur,India This is the fifth in a series of articles highlighting the delivery of ‘‘packages of care’’ for mental health disorders in low- and middle- incomecountries.Packagesofcarearecombinationsoftreatmentsaimed at improving the recognition and management of conditions to achieve optimaloutcomes. werelimitedhelpseeking[13]despitedisabilityandcarerstrain[15], no structured training on the recognition and management of dementia,andnoconstituencytoadvocateformoreresponsivecare services [14]. People with dementia were excluded from residential care[13].CarersmisinterpretedBPSDasdeliberatemisbehavior[14]. BPSDcanalsoleadtostigmaandblameattachingtothecarers[2].In India, likely causes of dementia were cited as ‘‘neglect by family members,abuse,tensionandlackoflove’’[13]. Introduction Inthisarticle,wefocusontheeffectivemanagementofdementia inLMICs,reviewingtheevidenceonefficacyofinterventionsand their delivery derived from LMICs where possible. Given the paucityofrelevantevidencefromLMICs,wealsocitesystematic reviewsandmeta-analysesbasedontrialsfromHICs.Onthebasis of our review we propose a package of care—a combination of treatmentsaimedatimprovingtherecognitionandmanagementof conditionstoachieveoptimaloutcomes—fordementia. Dementiaisachronicorganicbrainsyndrome,characterisedby progressive impairment of multiple cortical functions, including memory, learning, orientation, language, comprehension, and judgement. Diagnosis requires decline in cognitive function and independent living skills (Box 1) [1]. Ho