jgustavo51 
jgustavo1951 
jgustavo
Sender's message: DEMENTIA + CLINICAL GUIDELINES
Sent on: Tue Nov 8 23:30:21 2011 32 selected items
| pubmed Results |
| 1. | Can Fam Physician. 2011 Jul;57(7):e253-62.How applicable are clinical practice guidelines to elderly patients with comorbidities?Mutasingwa DR, Ge H, Upshur RE.SourcePublic Health and Preventive Medicine program, Dalla Lana School of Public Health, University of Toronto, Ontario. AbstractOBJECTIVE:To examine the applicability of 10 common clinical practice guidelines (CPGs) to elderly patients with multiple comorbidities. DESIGN:Content analysis of published Canadian CPGs for the following chronic diseases: diabetes, dyslipidemia, dementia, congestive heart failure, depression, osteoporosis, hypertension, gastroesophageal reflux disease, chronic obstructive pulmonary disease, and osteoarthritis. MAIN OUTCOME MEASURES:Presence or absence of 4 key indicators of applicability of CPGs to elderly patients with multiple comorbidities. These indicators include any mention of older adults or people with comorbidities, time needed to treat to benefit in the context of life expectancy, and barriers to implementation of the CPG. RESULTS:Out of the 10 CPGs reviewed, 7 mentioned treatment of the elderly, 8 mentioned people with comorbidities, 4 indicated the time needed to treat to benefit in the context of life expectancy, 5 discussed barriers to implementation, and 7 discussed the quality of evidence. CONCLUSION:This study shows that although most CPGs discuss the elderly population, only a handful of them adequately address issues related to elderly patients with comorbidities. In order to make CPGs more patient centred rather than disease driven, guideline developers should include information on elderly patients with comorbidities. |
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| 2. | Dtsch Arztebl Int. 2010 Oct;107(39):677-83. Epub 2010 Oct 1.New developments in the diagnosis of dementia.Eschweiler GW, Leyhe T, Klöppel S, Hüll M.SourceUniversitätsklinik für Psychiatrie und Psychotherapie Tübingen, Geriatrisches Zentrum am Universitätsklinikum Tübingen, Germany. gerhard.eschweiler@med.uni-tuebingen.de AbstractBACKGROUND:The terms "dementia" and "Alzheimer's disease" are often wrongly used as if they were synonyms. Dementia is a clinical syndrome whose main element is memory impairment; it is due to Alzheimer's disease in more than 75% of cases. Alzheimer's disease, on the other hand, is a neuropathological entity that is characterized by a protracted preclinical phase followed by the onset of slowly progressive dementia. METHODS:We here review relevant literature that we retrieved by a selective Medline search (2005-2009), paying special attention to the early diagnosis of Alzheimer's disease, its clinical manifestations, and its relevance in primary care. RESULTS:The early clinical manifestations of a dementing illness can be detected in primary care through the use of simple screening tests such as the mini mental state examination, clock drawing tests, and DemTect. A diminished concentration of Abeta-peptide and an increase of (phospho-)tau in the cerebrospinal fluid can suggest the presence of Alzheimer's disease even before the onset of dementia: these substances are components of amyloid plaques and neurofibrillary tangles, which are the characteristic neuropathological lesions of Alzheimer's disease. New types of morphological magnetic resonsance imaging (MRI), and automated analysis of the images obtained, can improve the consistency of radiological assessment over the traditional visual method and thus enable more secure diagnosis. CONCLUSION:The early, preclinical phase of Alzheimer's disease involves what has been termed mild cognitive impairment and may last as long as five years until the onset of dementia. With the aid of the new biomarkers described here, the likelihood of diagnosing Alzheimer's disease correctly in this phase can be raised above 80%. Early detection of Alzheimer's disease before the onset of dementia provides an opportunity to study potential approaches for secondary prevention, which are now an object of intense clinical research. |
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| 3. | Vasc Health Risk Manag. 2010 Aug 9;6:561-9.Practical recommendations for treatment of hypertension in older patients.Kithas PA, Supiano MA.SourceGeriatric Research, Education and Clinical Center, George E Wahlen Department of Veterans Affairs Medical Center, Department of Internal Medicine, Division of Geriatrics, University of Utah School of Medicine, Salt Lake City, Utah 84148, USA. philip.kithas@va.gov AbstractBACKGROUND:By the year 2030 the percent of the population over the age of 65 years is projected to range from 3.7% (in sub-Saharan Africa) to almost 22% (in Europe). Accompanying this unprecedented growth will be a significant increase in many of the disease processes or "comorbidities" associated with aging, not the least of which is hypertension. Global health care resources and economies in general will be stressed to breaking point if this condition is not dealt with in an aggressive and timely manner because the consequences of untreated hypertension such as stroke, myocardial infarction, and dementia are exceedingly costly in the long term. METHODS:To help focus attention on the worldwide epidemic of hypertension, the current literature and guidelines were reviewed, along with information on the various classes of medications indicated in the treatment of hypertension in the elderly. RESULTS:Recent, large, randomized trials indicate that hypertension in the elderly can and should be treated to lower the incidence of stroke, myocardial infarction, and chronic kidney disease. Although thiazide-type diuretics are the recommended first-line agents in most cases of uncomplicated hypertension, multiple drug classes have been shown to be useful. In addition, and where feasible, a multidisciplinary team approach has demonstrated the most durable results. CONCLUSION:Thiazide diuretics should be the first-line agents in uncomplicated, isolated systolic hypertension. Starting at low doses and proceeding in a gradual manner, these agents have proven efficacy in decreasing the risk of stroke and cardiovascular events. It is now recommended that these agents be used in low-dose combinations with other antihypertensive drug classes in patients who do not achieve target blood pressure (<140/90 mmHg). |
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| 4. | Neurology. 2010 Apr 20;74(16):1316-24. Epub 2010 Apr 12.Practice parameter update: evaluation and management of driving risk in dementia: report of the Quality Standards Subcommittee of the American Academy of Neurology.Iverson DJ, Gronseth GS, Reger MA, Classen S, Dubinsky RM, Rizzo M; Quality Standards Subcomittee of the American Academy of Neurology.SourceHumboldt Neurological Medical Group, Inc., Eureka, CA, USA. AbstractOBJECTIVE:To review the evidence regarding the usefulness of patient demographic characteristics, driving history, and cognitive testing in predicting driving capability among patients with dementia and to determine the efficacy of driving risk reduction strategies. METHODS:Systematic review of the literature using the American Academy of Neurology's evidence-based methods. RECOMMENDATIONS:For patients with dementia, consider the following characteristics useful for identifying patients at increased risk for unsafe driving: the Clinical Dementia Rating scale (Level A), a caregiver's rating of a patient's driving ability as marginal or unsafe (Level B), a history of crashes or traffic citations (Level C), reduced driving mileage or self-reported situational avoidance (Level C), Mini-Mental State Examination scores of 24 or less (Level C), and aggressive or impulsive personality characteristics (Level C). Consider the following characteristics not useful for identifying patients at increased risk for unsafe driving: a patient's self-rating of safe driving ability (Level A) and lack of situational avoidance (Level C). There is insufficient evidence to support or refute the benefit of neuropsychological testing, after controlling for the presence and severity of dementia, or interventional strategies for drivers with dementia (Level U). |
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| 5. | J Neuroradiol. 2010 May;37(2):122-6. Epub 2010 Mar 26.[Imaging of dementia in clinical routine. Recommendations of SFNR]. [Article in French] Delmaire C, Lehéricy S, Dormont D; le Bureau de la SFNR.SourceService de neuroradiologie, hôpital Roger-Salengro, CHRU de Lille, boulevard du Pr Laine, 59000 Lille, France. christine.chd@gmail.com |
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| 6. | Clin Interv Aging. 2009;4:425-33. Epub 2009 Nov 18.The inclusion of cognition in vascular risk factor clinical practice guidelines.Rockwood K, Middleton LE, Moorhouse PK, Skoog I, Black SE.SourceDepartment of Medicine, Dalhousie University, Halifax, NS, Canada. kenneth.rockwood@dal.ca AbstractBACKGROUND:People with vascular risk factors are at increased risk for cognitive impairment as well as vascular disease. The objective of this study was to evaluate whether vascular risk factor clinical practice guidelines consider cognition as an outcome or in connection with treatment compliance. METHODS:Articles from PubMed, EMBASE, and the Cochrane Library were assessed by at least two reviewers and were included if: (1) Either hypertension, high cholesterol, diabetes, or atrial fibrillation was targeted; (2) The guideline was directed at physicians; (3) Adult patients (aged 19 years or older) were targeted; and (4) The guideline was published in English. Of 91 guidelines, most were excluded because they were duplicates, older versions, or focused on single outcomes. RESULTS:Of the 20 clinical practice guidelines that met inclusion criteria, five mentioned cognition. Of these five, four described potential treatment benefits but only two mentioned that cognition may affect compliance. No guidelines adequately described how to screen for cognitive impairment. CONCLUSION:Despite evidence that links cognitive impairment to vascular risk factors, only a minority of clinical practice guidelines for the treatment of vascular risk factors consider cognition as either an adverse outcome or as a factor to consider in treatment. |
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| 7. | Can Fam Physician. 2009 May;55(5):506-7.e1-5.Family physicians and dementia in Canada: Part 1. Clinical practice guidelines: awareness, attitudes, and opinions.Pimlott NJ, Persaud M, Drummond N, Cohen CA, Silvius JL, Seigel K, Hollingworth GR, Dalziel WB.SourceWomen's College Hospital, 60 Grosvenor St, Toronto, ON M5S 1B6, Canada. nick.pimlott@utoronto.ca AbstractOBJECTIVE:To assess Canadian family physicians' awareness of, attitudes toward, and use of the 1999 Canadian Consensus Conference on Dementia (CCCD) clinical practice guidelines (CPGs); to explore the barriers and enablers to implementing dementia CPGs in clinical practice; and to identify more effective strategies for future dementia guideline development and dissemination. DESIGN:Qualitative study using focus groups. SETTING:Academic family practice clinics in Calgary, Alta, Ottawa, Ont, and Toronto, Ont. PARTICIPANTS:Eighteen family physicians. METHODS:Using a semistructured interview guide, we conducted 4 qualitative focus groups of 4 to 6 family physicians whose practices we had audited in a previous study. Transcripts were coded using an inductive data analytic strategy, and categories and themes were identified and described using the principles of thematic analysis. MAIN FINDINGS:Four major themes emerged from the focus group discussions. Family physicians 1) were minimally aware of the existence and the detailed contents of the CCCD guidelines; 2) had strong views about the purposes of guidelines in general; 3) expressed strong concerns about the role of the pharmaceutical industry in the development of such guidelines; and 4) had many ideas to improve future dementia guidelines and CPGs in general. CONCLUSION:Family physicians were minimally aware of the 1999 CCCD CPGs. They acknowledged, however, the potential of future CPGs to assist them in patient care and offered many strategies to improve the development and dissemination of future dementia guidelines. Future guidelines should more accurately reflect the day-to-day practice experiences and challenges of family physicians, and guideline developers should also be cognizant of family physicians' perceptions that pharmaceutical companies' funding of CPGs undermines the objectivity and credibility of those guidelines. |
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| 8. | CMAJ. 2008 Nov 4;179(10):1019-26.Diagnosis and treatment of dementia: 5. Nonpharmacologic and pharmacologic therapy for mild to moderate dementia.Hogan DB, Bailey P, Black S, Carswell A, Chertkow H, Clarke B, Cohen C, Fisk JD, Forbes D, Man-Son-Hing M, Lanctôt K, Morgan D, Thorpe L.SourceDepartment of Clinical Neurosciences, Health Sciences Centre, University of Calgary, 3330 Hospital Dr. NW, Calgary, ABT2N4N1. dhogan@ucalgary.ca AbstractBACKGROUND:Practising physicians frequently seek advice on the most effective interventions for dementia. In this article, we provide practical guidance on nonpharmacologic and pharmacologic interventions for the management of mild to moderate dementia based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. METHODS:We developed evidence-based guidelines using systematic literature searches, with specific criteria for the selection and quality assessment of articles, and a clear and transparent decision-making process. We selected articles published from January 1996 to December 2005 that dealt with the management of mild to moderate stages of Alzheimer disease and other forms of dementia. Recommendations based on the literature review were drafted and voted on. Consensus required 80% or more agreement by participants. Subsequent to the conference, we searched for additional articles published from January 2006 to April 2008 using the same major keywords and secondary search terms. We graded the strength of the evidence using the criteria of the Canadian Task Force on Preventive Health Care. RESULTS:We identified 1615 articles, of which 954 were selected for further study. From a synthesis of the evidence in these studies, we made 48 recommendations for the management of mild to moderate dementia (28) and dementia with a cerebrovascular component (8) as well as recommendations for addressing ethical issues (e.g., disclosure of the diagnosis) (12). The updated literature review did not change these recommendations. An exercise program is recommended for patients with mild to moderate dementia. Physicians should decide whether to prescribe a cholinesterase inhibitor on an individual basis, balancing anticipated benefits with the potential for harm. For mild mood and behavioural concerns, nonpharmacologic approaches should be considered first. INTERPRETATION:Although the available therapies for dementia can help with the management of symptoms, there is a need to develop more effective interventions. |
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| 9. | CMAJ. 2008 Oct 7;179(8):787-93.Diagnosis and treatment of dementia: 4. Approach to management of mild to moderate dementia.Hogan DB, Bailey P, Black S, Carswell A, Chertkow H, Clarke B, Cohen C, Fisk JD, Forbes D, Man-Son-Hing M, Lanctôt K, Morgan D, Thorpe L.SourceDepartments of Medicine and Clinical Neurosciences, University of Calgary, Calgary, Alta. dhogan@ucalgary.ca Erratum in
AbstractBACKGROUND:The management of mild to moderate dementia presents complex and evolving challenges. Practising physicians are often uncertain about the appropriate approaches to issues such as the disclosure of the diagnosis, driving and caregiver support. In this article, we provide practical guidance on management based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. METHODS:We developed evidence-based guidelines using systematic literature searches, with specific criteria for the selection and quality assessment of articles, and a clear and transparent decision-making process. We selected articles published from January 1996 to December 2005 that dealt with the management of mild to moderate stages of Alzheimer disease and other forms of dementia. Recommendations based on the literature review were drafted and voted on. Consensus required 80% or more agreement by participants. Subsequent to the conference, we searched for additional articles published from January 2006 to April 2008 using the same major keywords and secondary search terms. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care. RESULTS:We identified 1615 articles, of which 954 were selected for further study. From a synthesis of the evidence in these studies, we made 48 recommendations for the management of mild to moderate dementia (28) and dementia with a cerebrovascular component (8) as well as recommendations for addressing ethical issues (e.g., disclosure of the diagnosis) (12). The updated literature review did not change these recommendations. In brief, patients and their families should be informed of the diagnosis. Although the specifics of managing comorbid conditions might require modification, standards of care and treatment targets would not change because of a mild dementia. The use of medications with anticholinergic effects should be minimized. There should be proactive planning for driving cessation, since this will be required at some point in the course of progressive dementia. The patient's ability to drive should be determined primarily on the basis of his or her functional abilities. An important aspect of care is supporting the patient's primary caregiver. INTERPRETATION:Much has been learned about the care of patients with mild to moderate dementia and the support of their primary caregivers. There is a pressing need for the development, and dissemination, of collaborative systems of care. |
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| 10. | Int J Clin Pract. 2008 Oct;62(10):1581-7.Diagnosis and management of Parkinson's disease dementia.Poewe W, Gauthier S, Aarsland D, Leverenz JB, Barone P, Weintraub D, Tolosa E, Dubois B.SourceDepartment of Neurology, Medical University Innsbruck, Innsbruck, Austria. werner.poewe@uibk.ac.at AbstractParkinson's disease (PD) has long been considered predominantly a motor disorder. However, its frequent association with dementia, which contributes significantly to the morbidity and mortality of the condition, is gaining increasing recognition. PD dementia (PDD) has a unique clinical profile and neuropathology, distinct from Alzheimer's disease (AD). Cholinergic deficits, a feature of both AD and PDD, underlie the rationale for cholinesterase inhibitor therapy in both conditions. In clinical practice, it is important that PDD should be recognised and appropriately treated. This review aims to outline the recently proposed clinical diagnostic criteria for PDD and to summarise the guidelines/recommendations published since 2006 on the use of cholinesterase inhibitors in the management of PDD. Although the cholinesterase inhibitor rivastigmine has recently been approved for the management of PDD, there remains a need for the development of novel therapies that can affect key mechanisms of the disease or prevent/delay patients with PD and mild cognitive impairment from progressing to PDD. |
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| 11. | Neuroepidemiology. 2008;30(4):254-65. Epub 2008 Jun 2.Development of screening guidelines and clinical criteria for predementia Alzheimer's disease. The DESCRIPA Study.Visser PJ, Verhey FR, Boada M, Bullock R, De Deyn PP, Frisoni GB, Frolich L, Hampel H, Jolles J, Jones R, Minthon L, Nobili F, Olde Rikkert M, Ousset PJ, Rigaud AS, Scheltens P, Soininen H, Spiru L, Touchon J, Tsolaki M, Vellas B, Wahlund LO, Wilcock G, Winblad B.SourceDepartment of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, The Netherlands. pj.visser@np.unimaas.nl AbstractBACKGROUND:There is an urgent need to identify subjects with Alzheimer's disease (AD) in the predementia phase, but validated diagnostic approaches are currently lacking. In this paper, we present the background, design and methods of a study, which aims to develop clinical criteria for predementia AD. We also present baseline characteristics of the subjects included. The study was part of the multicentre DESCRIPA project, which is being conducted within the network of the European Alzheimer's Disease Consortium. METHODS:Clinical criteria will be based on a prospective cohort study of non-demented subjects older than 55 years and referred to a memory clinic. At baseline, a number of markers and risk factors for AD were collected, including demographic variables, measures of performance in activities of daily living, cognitive, neuroimaging and genetic markers, and serum and cerebrospinal fluid markers. Subjects will be reassessed annually for 2-3 years, and we will evaluate which combination of variables best predicts AD-type dementia at follow-up. RESULTS:Between 2003 and 2005, 881 subjects were included from 20 memory clinics. Subjects were on average 70.3 years old, and had 10.4 years of education. The average score on the Mini-Mental State Examination was 27.4. Copyright 2008 S. Karger AG, Basel. |
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| 12. | Br J Radiol. 2007 Dec;80 Spec No 2:S153-9.SPECT imaging in dementia.Pimlott SL, Ebmeier KP.SourceRadiopharmaceutical Research & Development, West of Scotland Radionuclide Dispensary, Western Infirmary, Dumbarton Road, Glasgow, UK. AbstractSingle photon emission computed tomography (SPECT) is a non-invasive functional neuroimaging technique that can be used in the diagnosis of dementia. This review describes some of the SPECT radiotracers available for imaging dementia patients and discusses recommendations for the clinical use of this imaging technique. |
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| 13. | CMAJ. 2008 Mar 25;178(7):825-36.Diagnosis and treatment of dementia: 2. Diagnosis.Feldman HH, Jacova C, Robillard A, Garcia A, Chow T, Borrie M, Schipper HM, Blair M, Kertesz A, Chertkow H.SourceDivision of Neurology, Department of Medicine, University of British Columbia, and the University of British Columbia Hospital Clinic for Alzheimer's Disease and Related Disorders, Vancouver, BC. hfeldman@interchange.ubc.ca AbstractBACKGROUND:Dementia can now be accurately diagnosed through clinical evaluation, cognitive screening, basic laboratory evaluation and structural imaging. A large number of ancillary techniques are also available to aid in diagnosis, but their role in the armamentarium of family physicians remains controversial. In this article, we provide physicians with practical guidance on the diagnosis of dementia based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, held in March 2006. METHODS:We developed evidence-based guidelines using systematic literature searches, with specific criteria for study selection and quality assessment, and a clear and transparent decision-making process. We selected studies published from January 1996 to December 2005 that pertained to key diagnostic issues in dementia. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care. RESULTS:Of the 1591 articles we identified on all aspects of dementia diagnosis, 1095 met our inclusion criteria; 620 were deemed to be of good or fair quality. From a synthesis of the evidence in these studies, we made 32 recommendations related to the diagnosis of dementia. There are clinical criteria for diagnosing most forms of dementia. A standard diagnostic evaluation can be performed by family physicians over multiple visits. It involves a clinical history (from patient and caregiver), a physical examination and brief cognitive testing. A list of core laboratory tests is recommended. Structural imaging with computed tomography or magnetic resonance imaging is recommended in selected cases to rule out treatable causes of dementia or to rule in cerebrovascular disease. There is insufficient evidence to recommend routine functional imaging, measurement of biomarkers or neuropsychologic testing. INTERPRETATION:The diagnosis of dementia remains clinically integrative based on history, physical examination and brief cognitive testing. A number of core laboratory tests are also recommended. Structural neuroimaging is advised in selected cases. Other diagnostic approaches, including functional neuroimaging, neuropsychological testing and measurement of biomarkers, have shown promise but are not yet recommended for routine use by family physicians. |
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| 14. | Ann Intern Med. 2008 Mar 4;148(5):379-97.Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline.Raina P, Santaguida P, Ismaila A, Patterson C, Cowan D, Levine M, Booker L, Oremus M.SourceMcMaster University, Hamilton, Ontario, Canada. praina@mcmaster.ca Comment inSummary for patients inAbstractBACKGROUND:The effectiveness of the 5 U.S. Food and Drug Administration-approved pharmacologic therapies for dementias in achieving clinically relevant improvements is unclear. PURPOSE:To review the evidence for the effectiveness of cholinesterase inhibitors (donepezil, galantamine, rivastigmine, and tacrine) and the neuropeptide-modifying agent memantine in achieving clinically relevant improvements, primarily in cognition, global function, behavior, and quality of life, for patients with dementia. DATA SOURCES:Cochrane Central Register of Controlled Trials, MEDLINE, PREMEDLINE, EMBASE, Allied and Complementary Medicine Database, CINAHL, AgeLine, and PsycINFO from January 1986 through November 2006. STUDY SELECTION:English-language randomized, controlled trials were included in the review if they evaluated pharmacologic agents for adults with a diagnosis of dementia, did not use a crossover design, and had a quality score of at least 3 on the Jadad scale. DATA EXTRACTION:Data were extracted on study characteristics and outcomes, including adverse events. Effect sizes were calculated and data were combined when appropriate. DATA SYNTHESIS:96 publications representing 59 unique studies were eligible for this review. Both cholinesterase inhibitors and memantine had consistent effects in the domains of cognition and global assessment, but summary estimates showed small effect sizes. Outcomes in the domains of behavior and quality of life were evaluated less frequently and showed less consistent effects. Most studies were of short duration (6 months), which limited their ability to detect delay in onset or progression of dementia. Three studies directly compared different cholinesterase inhibitors and found no differences in cognition and behavior. LIMITATIONS:Limitations of available studies included short duration, inclusion of only patients with mild to moderate Alzheimer disease, poor reporting of adverse events, lack of clear definitions for statistical significance, limited evaluation of behavior and quality-of-life outcomes, and limited direct comparison of different treatments. CONCLUSIONS:Treatment of dementia with cholinesterase inhibitors and memantine can result in statistically significant but clinically marginal improvement in measures of cognition and global assessment of dementia. |
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| 15. | Ann Intern Med. 2008 Mar 4;148(5):370-8.Current pharmacologic treatment of dementia: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians.Qaseem A, Snow V, Cross JT Jr, Forciea MA, Hopkins R Jr, Shekelle P, Adelman A, Mehr D, Schellhase K, Campos-Outcalt D, Santaguida P, Owens DK; American College of Physicians/American Academy of Family Physicians Panel on Dementia.SourceAmerican College of Physicians and University of Pennsylvania, Philadelphia, Pennsylvania 19106, USA. aqaseem@acponline.org Summary for patients inAbstractDESCRIPTION: The American College of Physicians and American Academy of Family Physicians developed this guideline to present the available evidence on current pharmacologic treatment of dementia. METHODS: The targeted literature search included evidence related to the effectiveness of 5 U.S. Food and Drug Administration-approved pharmacologic therapies for dementia for outcomes in the domains of cognition, global function, behavior/mood, and quality of life/activities of daily living. RECOMMENDATION 1: Clinicians should base the decision to initiate a trial of therapy with a cholinesterase inhibitor or memantine on individualized assessment. (Grade: weak recommendation, moderate-quality evidence.) RECOMMENDATION 2: Clinicians should base the choice of pharmacologic agents on tolerability, adverse effect profile, ease of use, and cost of medication. The evidence is insufficient to compare the effectiveness of different pharmacologic agents for the treatment of dementia. (Grade: weak recommendation, low-quality evidence.) RECOMMENDATION 3: There is an urgent need for further research on the clinical effectiveness of pharmacologic management of dementia. |
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| 16. | Age Ageing. 2007 Nov;36(6):605-6.Treating dementia: will the NICE guidance 2006 change our clinical practice?Cerejeira J, Mukaetova-Ladinska EB. Free Article |
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| 17. | Can J Neurol Sci. 2007 Mar;34 Suppl 1:S1-130.Canadian Guidelines for the Development of Antidementia Therapies. Proceedings of the 2nd Canadian Conference on Antidementia Drug Guidelines, March 2007.[No authors listed] Free Article |
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| 18. | Age Ageing. 2007 May;36(3):331-3. Epub 2007 Mar 9.Cholinesterase inhibitors and cardiovascular disease: a survey of old age psychiatrists' practice.Malone DM, Lindesay J.SourceClinical Division of Psychiatry, Department of Health Sciences, Leicester General Hospital, Leicester, UK. dm91@le.ac.uk Comment in |
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| 19. | Can J Neurol Sci. 2006 Feb;33(1):6-26.Progress in clinical neurosciences: Canadian guidelines for the development of antidementia therapies: a conceptual summary.Feldman HH, Gauthier S, Chertkow H, Conn DK, Freedman M, Chris M; 2nd Canadian Conference on Antidementia Guidelines.SourceDivision of Neurology, University of British Columbia, Clinic for Alzheimer's Disease and Related Disorders, Vancouver, BC, Canada. AbstractThe magnitude of the problems faced by an aging Canadian society has been clearly identified. Perhaps the single most important problem is the increasing incidence of dementia. Alzheimer's disease (AD) accounts for 50-60% of the dementias in later life within a spectrum of other contributing dementias. Regulatory approval has been given to Acetylcholinesterase inhibitors for the symptomatic treatment of mild to moderate AD, and conditional approval to memantine for the symptoms of moderate to severe AD. There has been no regulatory approval for the treatment of the degenerative dementias beyond AD. The very rapid progress in the past decade in biotechnology and in the molecular biology of the dementias is supporting a new generation of innovative treatment strategies that will more directly target the underlying disease pathogenic mechanisms. Such treatments will foreseeably include immunotherapies, anti-aggregants that may prevent misfolding and deposition of proteins, and neuroregenerative interventions. These Guidelines follow the 2nd Canadian Conference on the Development of Antidementia Therapies, held in 2004, which covered a range of design, methodological and ethical issues facing clinical researchers and regulatory authorities. They are intended to provide a common point of reference and guidance in Canada for therapeutic development of the dementias. |
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| 20. | Can J Neurol Sci. 2006 Feb;33(1):5.Alzheimer's disease clinical trials: where are we now?Cummings J. Free Article |
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| 21. | Arq Neuropsiquiatr. 2005 Sep;63(3A):720-7. Epub 2005 Sep 9.[Diagnosis of Alzheimer's disease in Brazil: cognitive and functional evaluation. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology]. [Article in Portuguese] Nitrini R, Caramelli P, Bottino CM, Damasceno BP, Brucki SM, Anghinah R; Academia Brasileira de Neurologia.SourceDepartamento Científico de Neurologia Cognitiva e do Envelhecimento, Academia Brasileira de Neurologia, Brazil. nitrini@uol.com.br AbstractThe educational and cultural heterogeneity of the Brazilian population leads to peculiar characteristics regarding the diagnosis of Alzheimer's disease (AD). This consensus had the objective of recommending evidence-based guidelines for the clinical diagnosis of AD in Brazil. Studies on the diagnosis of AD published in Brazil were systematically evaluated in a thorough research of PUBMED and LILACS databases. For global cognitive evaluation, the Mini-Mental State Examination was recommended; for memory evaluation: delayed recall subtest of CERAD or of objects presented as drawings; attention: trail-making or digit-span; language: Boston naming, naming test from ADAS-Cog or NEUROPSI; executive functions: verbal fluency or clock-drawing; conceptualization and abstraction: similarities from CAMDEX or NEUROPSI; construction: drawings from CERAD. For functional evaluation, IQCODE, or Pfeffer Questionnaire or Bayer Scale for Activities of Daily Living was recommended. The panel concluded that the combined use of cognitive and functional evaluation based on interview with informant is recommended. |
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| 22. | Arq Neuropsiquiatr. 2005 Sep;63(3A):713-9. Epub 2005 Sep 9.[Diagnosis of Alzheimer's disease in Brazil: diagnostic criteria and auxiliary tests. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology]. [Article in Portuguese] Nitrini R, Caramelli P, Bottino CM, Damasceno BP, Brucki SM, Anghinah R; Academia Brasileira de Neurologia.SourceDepartamento Científico de Neurologia Cognitiva e do Envelhecimento, Academia Brasileira de Neurologia, Brazil. nitrini@uol.com.br AbstractThis panel had the objective of recommending evidence-based guidelines for the clinical diagnosis of Alzheimer's disease (AD) in Brazil. Guidelines from other countries and papers on the diagnosis of AD in Brazil were systematically evaluated in a thorough research of PUBMED and LILACS databases. The panel concluded that dementia diagnosis should be based on the DSM criteria and AD diagnosis, on the McKhann et al. criteria (NINCDS-ADRDA). The recommended auxiliary tests are: blood cell count, blood urea nitrogen, serum levels of creatinine, free-thyroxine, thyroid-stimulant hormone, albumin, hepatic enzymes, vitamin B12 and calcium, serological tests for syphilis and, for those aged less than 60 years, serological tests for HIV. Cerebrospinal fluid examination is recommended in special situations. Computed tomography (or preferentially magnetic resonance imaging, when available) is mandatory and has the main objective of excluding other diseases. SPECT and EEG are optional diagnostic methods. |
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| 23. | Tidsskr Nor Laegeforen. 2005 Jun 16;125(12):1672-5.[Antipsychotics against anxiety in dementia: medical treatment or chemical restraints?]. [Article in Norwegian] Ruths S, Straand J.SourceSeksjon for allmennmedisin, Institutt for samfunnsmedisinske fag, Universitetet i Bergen, 5018 Bergen. sabine.ruths@isf.uib.no AbstractBACKGROUND:Antipsychotic drugs are widely used for behavioural and psychological symptoms of dementia. We discuss the evidence for this treatment and implications for clinical practice. METHOD:Literature search on Medline was supplemented by clinical guidelines and drug reports. RESULTS AND INTERPRETATION:Treatment with antipsychotic drugs for behavioural symptoms has limited effectiveness; the documentation is generally weaker for older than for newer drugs. Conventional antipsychotics give important risks of adverse events, while the newer antipsychotics imply increased risk of cerebrovascular events; hence, monitoring of effect and adverse events is imperative. Standardised methods for assessing behavioural symptoms, e.g. the Neuropsychiatric Inventory, are suitable for follow up. Controlled trials indicate that withdrawal is a feasible method for assessing actual drug effect and the need for continued treatment. Withdrawal attempts should therefore be conducted regularly for all patients taking antipsychotics for behavioural and psychological symptoms of dementia. |
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| 24. | Perm J. 2005 Spring;9(2):83-8.Evidence-based guidelines.Barrett PH, Okawa G, Bowman J.AbstractThe Advanced/Policy Track of the 2004 Kaiser Permanente Evidence-Based Medicine Symposium was an interactive session that focused on developing evidence-based clinical practice guidelines. The hypothetical scenario involved the imaginary drug "Memoryboost," a treatment for dementia. The participants were given materials describing the national Kaiser Permanente (KP) methodology for developing evidence-based guidelines and a summary of the highest-quality articles about the efficacy of this drug. The participants then formed small groups and used this information to develop a recommendation about its use for the treatment of dementia. In spite of having the same evidence, the groups developed three different recommendations. The entire group then explored some of the reasons for this variability. This article also addresses the reasons KP develops its own national guidelines, as well as who oversees the national guideline initiative and who develops guidelines. |
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| 25. | MedGenMed. 2004 Jan 15;6(1):48.Diet and Alzheimer's disease: what the evidence shows.Morris MC.SourceRush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois, USA. |
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| 26. | MedGenMed. 2004 Mar 11;6(1):30.Should older adults be screened for cognitive impairment?Borson S.SourceUniversity of Washington School of Medicine, Seattle, Washington, USA. |
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| 27. | Neurol Med Chir (Tokyo). 2004 Apr;44(4):222-3.Clinical guidelines for idiopathic normal pressure hydrocephalus.Ishikawa M; Guideline Committe for Idiopathic Normal Pressure Hydrocephalus, Japanese Society of Normal Pressure Hydrocephalus.SourceDepartment of Neurosurgery, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Oogi-machi, Kita-ku, Osaka 539-8480, Japan. mishika@kitano-hp.or.jp AbstractIdiopathic normal pressure hydrocephalus (iNPH) is a syndrome characterized by gait disturbance, dementia, and/or urinary incontinence without causative disorders, and ventricular enlargement due to disturbance of the cerebrospinal fluid (SF) circulation. The number of patients with iNPH will increase with the aging of the population in Japan. However, iNPH is often difficult to differentiate from other senile disorders such as lumbar canal stenosis, parkinsonism, and so on. Clinical guidelines for iNPH are required to improve understanding and provide for patients' quality of life and social care. These guidelines propose three levels of iNPH: possible, probable, and definite. Possible iNPH includes one or more of the classical triad and ventricular dilation in middle aged and elderly patients with closing of the CSF space at high convexity on magnetic resonance imaging. Probable iNPH shows improvement of the symptoms after CSF removal in patients with possible iNPH. Definite iNPH shows clinical improvement after CSF shunt operation. The CSF tap test is a major diagnostic measure because of the simplicity and less invasiveness. Use of the programmable valve is recommended to decrease CSF overdrainage. These guidelines are helpful for the diagnosis and treatment of iNPH. |
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| 28. | Rev Neurol. 2003 Nov 1-15;37(9):860-70.[Systematic review of the value of positron emission tomography in the diagnosis of Alzheimer's disease]. [Article in Spanish] Carnero-Pardo C.SourceServicio de Neurología, Hospital Virgen de las Nieves, Granada, España. ccarnerop@supercable.es AbstractINTRODUCTION:A great deal of controversy has arisen about the role positron emission tomography (PET) has to play in the diagnostic assessment of Alzheimer s disease (AD). AIMS. The objective of this study is to review, assess and synthesize existing evidence about the value of PET in the prediction of the progression towards dementia undergone by subjects with mild cognitive impairment and in the differential diagnosis of AD from other types of dementia. DEVELOPMENT:We performed a systematic review with explicit search criteria in primary and secondary databases in order to locate documents that could serve our research purposes. Selection and assessment of the quality of the documents found was performed according to a set of pre established criteria. The search for secondary sources yielded nine technical reports, a clinical guideline and a systematic review. To sum up their conclusions it would appear that little work has been published, it is of poor quality and the findings are against the routine use of this technology. The search in primary sources produced three original scientific papers dealing with its value in prediction and two others that referred to differential diagnosis; this new evidence did not, however, modify the previous conclusions. CONCLUSIONS:At present, and according to available evidence, the routine use of PET cannot be recommended in the diagnostic assessment of AD. The number of original works available is very low and, generally speaking, they offer important methodological limitations. |
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| 29. | Am Fam Physician. 2003 Oct 1;68(7):1365-72.Pharmacologic treatment of Alzheimer's disease: an update.DeLaGarza VW.SourceDepartment of Family Medicine, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA. vdelagarza@pol.net AbstractAlzheimer's disease is characterized by the development of senile plaques and neurofibrillary tangles, which are associated with neuronal destruction, particularly in cholinergic neurons. Drugs that inhibit the degradation of acetylcholine within synapses are the mainstay of therapy. Donepezil, rivastigmine, and galantamine are safe but have potentially troublesome cholinergic side effects, including nausea, anorexia, diarrhea, vomiting, and weight loss. These adverse reactions are often self-limited and can be minimized by slow drug titration. Acetylcholinesterase inhibitors appear to be effective, but the magnitude of benefit may be greater in clinical trials than in practice. The drugs clearly improve cognition, but evidence is less robust for benefits in delaying nursing home placement and improving functional ability and behaviors. Benefit for vitamin E or selegiline has been suggested, but supporting evidence is not strong. Most guidelines for monitoring drug therapy in patients with Alzheimer's disease recommend periodic measurements of cognition and functional ability. The guidelines generally advise discontinuing therapy with acetylcholinesterase inhibitors when dementia becomes severe. |
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| 30. | J Am Soc Nephrol. 2003 Jul;14(7 Suppl 2):S92-8.Prevention of hypertension and its complications: theoretical basis and guidelines for treatment.Flack JM, Peters R, Shafi T, Alrefai H, Nasser SA, Crook E.SourceDepartment of Internal Medicine, College of Nursing, Divisions of General Internal Medicine, Wayne State University, Detroit, Michigan, USA. jflack@intmed.wayne.edu AbstractHypertension is a nutritional-hygienic disease. Long-term caloric intake in excess of energy expenditures, chronic supraphysiological intake of dietary sodium, excessive alcohol consumption, and psychosocial stressors all contribute to the development of hypertension throughout the world. Elevated BP, particularly systolic BP, has been linked to multiple adverse clinical outcomes including stroke, heart failure, myocardial infarction, renal insufficiency/failure, peripheral vascular disease, retinopathy, dementia, and premature mortality. These undesirable clinical outcomes are typically, although not invariably, preceded by pressure-related target-organ injury such as left ventricular hypertrophy, renal insufficiency and proteinuria. The relation of BP and CKD and, in turn, the prevention of CKD or forestalling its progression by hypertension treatment, will be the focus of this manuscript. In hypertensive persons with reduced kidney function and/or proteinuria, lowering BP with multidrug therapy that is inclusive of pharmacologic modulators of the renin-angiotensin-aldosterone-kinin system is an effective strategy to forestall the progressive loss of kidney function. The totality of data support low therapeutic BP targets for persons with proteinuria >1 g/d. Nevertheless, in persons with CKD, even those with proteinuria below the dipstick positive level (approximately 300 mg/d or urine protein to creatinine ratio of 0.22), aggressive BP control also may be warranted because of the high risk of nonrenal cardiovascular disease. Multiple antihypertensive drugs will be required in the vast majority of patients with diabetes and/or reduced kidney function to attain BP goal. Renin-angiotensin system (RAS) modulator therapy is indicated among persons with diabetes mellitus and CKD. Available data support the use of angiotensin receptor blockers in persons with type 2 diabetes and overt nephropathy for preservation of kidney function. Among persons with type I diabetes with or without overt nephropathy, type 2 diabetes without overt nephropathy and in nondiabetic CKD, the available clinical data support the use of angiotensin-converting enzyme inhibitors as the RAS modulator of choice. Low therapeutic target BP levels <130/80 mmHg in persons with type 2 diabetes mellitus also appear warranted based on available data mostly for reducing the risk of nonrenal cardiovascular disease and overall mortality. |
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| 31. | Arch Intern Med. 2000 Oct 9;160(18):2855-62.Systematic review of clinical prediction rules for neuroimaging in the evaluation of dementia.Gifford DR, Holloway RG, Vickrey BG.SourceDivision of Geriatrics, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, USA. David_Gifford@Brown.edu AbstractBACKGROUND:Clinical practice guidelines for dementia do not recommend routine neuroimaging but vary in their recommended clinical prediction rules to identify patients who should undergo neuroimaging for potentially reversible causes of dementia. METHODS:Using a MEDLINE search supplemented by other strategies, we identified studies from January 1, 1983, through December 31, 1998, that evaluated the diagnostic performance of a clinical prediction rule. We calculated the sensitivity and specificity of each rule, then evaluated their diagnostic performance in a hypothetical cohort of 1000 patients with dementia, varying the prevalence of potentially reversible dementia from 1% to 15%. RESULTS:We identified 7 studies that evaluated at least 1 of 6 different clinical prediction rules. Only one rule consistently had high sensitivity (>85%) across all studies; none consistently had high specificity (>85%). Six of the 7 studies included less than 15 cases of potentially reversible dementia; thus the sensitivity and specificity for each rule had relatively wide confidence intervals. At a 5% prevalence of potentially reversible dementia, all rules had low positive predictive value (<15%) in our hypothetical cohort. Depending on the rule, our analysis predicts 6 to 44 of the 50 patients with potentially reversible dementia (5% prevalence in cohort of 1000 patients) would not undergo imaging. CONCLUSIONS:There is considerable uncertainty in the evidence underlying clinical prediction rules to identify which patients with dementia should undergo neuroimaging. Application of these rules may miss patients with potentially reversible causes of dementia. |
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| 32. | AJNR Am J Neuroradiol. 1999 Feb;20(2):207-11.A quantitative MR study of the hippocampal formation, the amygdala, and the temporal horn of the lateral ventricle in healthy subjects 40 to 90 years of age.Mu Q, Xie J, Wen Z, Weng Y, Shuyun Z.SourceDepartment of Radiology, the Third School of Clinical Medicine, Beijing Medical University, China. AbstractBACKGROUND AND PURPOSE:Several investigators have defined normal age-specific values for the medial temporal lobe structures in neurologically normal elderly subjects, but, to our knowledge, no one has reported those values for a large sample of healthy volunteers. The purpose of our study was to define normal age-specific values for the hippocampal formation, the amygdala, and the temporal horn of the lateral ventricle by age group, ranging from 40 to 90 years, in order to generate a guideline for the quantitative MR diagnosis and differential diagnosis for early Alzheimer disease. METHODS:MR-based volumetric measurements of the hippocampal formation, the amygdala, and the temporal horn, standardized by total intracranial volume, were obtained from oblique coronal and sagittal T1-weighted MR images in 619 healthy volunteers and two cadaveric specimens. RESULTS:Differences in standardized volumes of the hippocampal formation, the amygdala, and the temporal horn were significant among the 61- to 70-year-old, 71- to 80-year-old, and 81- to 90-year-old groups, and were not significant between the 40- to 50-year-old and 51- to 60-year-old groups. We found no significant differences in side or sex among the age groups for any of the structures. CONCLUSION:Differences in the mean value and in the 95% normal range of standardized volumes of the hippocampal formation, the amygdala, and the temporal horn correspond to differences in age among healthy subjects; therefore, age should be considered a factor in correlative research, especially in that involving patients in the early stages of Alzheimer disease. |
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