INTRODUCTION Approximately 2 million people in Italy are currently living with dementia or mild cognitive impairment (MCI), and 4 million are involved as family members or caregivers. Considering the significant impact of dementia, the Italian Ministry of Health entrusted the Italian National Institute of Health (Istituto Superiore di Sanità) with the development of a guideline within the Italian National Guideline System (Sistema Nazionale Linee Guida, SNLG) on the diagnosis and treatment of dementia and MCI. The main objective was to provide evidence-based recommendations aimed at reducing the variability and ensuring the appropriateness of clinical practices throughout the whole care process from identification and diagnosis to the end of life for people with dementia (PwD) or MCI and their families/caregivers. METHODS The GRADE-ADOLOPMENT approach was used to adopt, adapt and update the guideline developed by the National Institute for Health and Care Excellence in 2018 (NG97). The methodology was based on the Methodological Handbook produced by the SNLG. A multidisciplinary panel of 29 experts and four representatives of family members/caregivers discussed and approved 47 review questions. Of these, 34 questions were adopted from the NG97, and 13 were new questions, including 10 questions referring to MCI. Systematic literature reviews were performed for each question, and a team of methodological and clinical experts qualitatively assessed and summarised results from included studies based on the GRADE approach. To facilitate the implementation and dissemination of the contents of this guideline, a care pathway and a leaflet dedicated to PwD or MCI and their families/caregivers were also developed. RESULTS The literature review for this guideline included studies published up to November 2023. More than 1000 peer-reviewed publications were included, covering the following areas: (i) identification, diagnosis and post-diagnostic support; (ii) care models and care coordination; (iii) pharmacological interventions for cognitive symptoms; (iv) non-pharmacological interventions for cognitive symptoms; (v) non-cognitive symptoms, intercurrent illnesses and palliative care. The multidisciplinary panel discussed and approved 167 clinical practice recommendations and 39 research recommendations. COMMENTARY Italy's first National Guideline on dementia and MCI addresses diagnosis, treatment and care within the National Healthcare System. It includes recommendations on pharmacological and non-pharmacological approaches, and emphasises tailored interventions, comprehensive cognitive assessment, staff training and palliative care. The guideline also underlines the need to involve PwD in decision-making and supporting caregivers throughout the entire course of the disease. CONCLUSIONS Structured strategies for the dissemination and implementation of the guideline will be defined within the Italian Fund for Alzheimer and other Dementias 2024-2026. An interactive care pathway and a leaflet dedicated to PwD and their carers are already available. The guideline will be updated starting January 2027, but early updates may be planned in case of breakthrough advancements.

中文翻译：

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意大利痴呆和轻度认知障碍诊断和治疗指南。


引言 意大利目前约有 200 万人患有痴呆或轻度认知障碍 （MCI），其中 400 万人作为家庭成员或护理人员参与其中。考虑到痴呆症的重大影响，意大利卫生部委托意大利国家卫生研究所（Istituto Superiore di Sanità）在意大利国家指南系统（Sistema Nazionale Linee Guida，SNLG）内制定关于痴呆和MCI诊断和治疗的指南。主要目标是提供基于证据的建议，旨在减少痴呆症患者 （PwD） 或 MCI 及其家人/护理人员从识别和诊断到生命结束的整个护理过程中临床实践的适当性。方法 GRADE-ADOLOPMENT 方法用于采用、调整和更新国家卫生与临床优化研究所 （NG97） 于 2018 年制定的指南。该方法基于 SNLG 编制的《方法手册》。由 29 名专家和 4 名家庭成员/照护者代表组成的多学科小组讨论并批准了 47 个综述问题。其中，34 个问题是从 NG97 中采纳的，13 个是新问题，包括 10 个涉及 MCI 的问题。对每个问题进行系统的文献综述，一组方法学和临床专家根据 GRADE 方法对纳入研究的结果进行定性评估和总结。为了促进本指南内容的实施和传播，还制定了专门针对 PwD 或 MCI 及其家人/护理人员的护理路径和传单。 结果 本指南的文献综述纳入了截至 2023 年 11 月发表的研究。纳入了 1000 多篇同行评审出版物，涵盖以下领域：（i） 识别、诊断和诊断后支持;（ii） 护理模式和护理协调;（iii） 认知症状的药物干预;（iv） 针对认知症状的非药物干预;（v） 非认知症状、并发疾病和姑息治疗。多学科小组讨论并批准了 167 项临床实践建议和 39 项研究建议。评论 意大利第一份关于痴呆和 MCI 的国家指南涉及国家医疗保健系统内的诊断、治疗和护理。它包括关于药物和非药物方法的建议，并强调量身定制的干预措施、全面的认知评估、员工培训和姑息治疗。该指南还强调需要让 PwD 参与决策，并在整个疾病过程中为护理人员提供支持。结论 将在意大利阿尔茨海默病和其他痴呆症基金 2024-2026 内确定传播和实施指南的结构化策略。交互式护理路径和专门针对 PwD 及其护理人员的传单已经可用。该指南将从 2027 年 1 月开始更新，但如果有突破性进展，可能会计划提前更新。