Dementia is a common and progressive condition whose prevalence is growing worldwide. It is challenging for healthcare systems to provide continuity in clinical services for all patients from diagnosis to death.

To test whether individuals who are most likely to need enhanced care later in the disease course can be identified at the point of diagnosis, thus allowing the targeted intervention.

We used clinical information collected routinely in de-identified electronic patient records from two UK National Health Service (NHS) trusts to identify at diagnosis which individuals were at increased risk of needing enhanced care (psychiatric in-patient or intensive (crisis) community care).

We examined the records of a total of 25 326 patients with dementia. A minority (16% in the Cambridgeshire trust and 2.4% in the London trust) needed enhanced care. Patients who needed enhanced care differed from those who did not in age, cognitive test scores and Health of the Nation Outcome Scale scores. Logistic regression discriminated risk, with an area under the receiver operating characteristic curve (AUROC) of up to 0.78 after 1 year and 0.74 after 4 years. We were able to confirm the validity of the approach in two trusts that differed widely in the populations they serve.

It is possible to identify, at the time of diagnosis of dementia, individuals most likely to need enhanced care later in the disease course. This permits the development of targeted clinical interventions for this high-risk group.

痴呆症是一种常见且进行性的疾病，其患病率在全球范围内不断增加。医疗保健系统为所有患者提供从诊断到死亡的连续性临床服务具有挑战性。

测试是否可以在诊断时识别出在病程后期最有可能需要加强护理的个体，从而进行有针对性的干预。

我们使用从两个英国国家医疗服务 (NHS) 信托机构的去识别化电子患者记录中定期收集的临床信息来识别哪些个体需要加强护理的风险较高（精神病住院患者或重症（危机）社区护理） 。

我们检查了总共 25 326 名痴呆症患者的记录。少数人（剑桥郡信托基金中的 16% 和伦敦信托基金中的 2.4%）需要加强护理。需要加强护理的患者与不需要加强护理的患者在年龄、认知测试分数和国家健康结果量表分数上有所不同。 Logistic 回归可区分风险，受试者工作特征曲线下面积 (AUROC) 1 年后高达 0.78，4 年后高达 0.74。我们能够在两个信托机构中证实该方法的有效性，这两个信托机构所服务的人群差异很大。

在诊断痴呆症时，可以识别出在病程后期最有可能需要加强护理的个体。这使得针对这一高危人群制定有针对性的临床干预措施成为可能。