A European Academy of Neurology guideline on medical management issues in dementia

Abstract

Background and purpose Dementia is one of the most common disorders and is associated with increased morbidity, mortality and decreased quality of life. The present guideline addresses important medical management issues including systematic medical follow‐up, vascular risk factors in dementia, pain in dementia, use of antipsychotics in dementia and epilepsy in dementia. Methods A systematic review of the literature was carried out. Based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework, we developed a guideline. Where recommendations based on GRADE were not possible, a good practice statement was formulated. Results Systematic management of vascular risk factors should be performed in patients with mild to moderate dementia as prevention of cerebrovascular pathology may impact on the progression of dementia (Good Practice statement). Individuals with dementia (without previous stroke) and atrial fibrillation should be treated with anticoagulants (weak recommendation). Discontinuation of opioids should be considered in certain individuals with dementia (e.g. for whom there are no signs or symptoms of pain or no clear indication, or suspicion of side effects; Good Practice statement). Behavioral symptoms in persons with dementia should not be treated with mild analgesics (weak recommendation). In all patients with dementia treated with opioids, assessment of the individual risk–benefit ratio should be performed at regular intervals. Regular, preplanned medical follow‐up should be offered to all patients with dementia. The setting will depend on the organization of local health services and should, as a minimum, include general practitioners with easy access to dementia specialists (Good Practice statement). Individuals with dementia and agitation and/or aggression should be treated with atypical antipsychotics only after all non‐pharmacological measures have been proven to be without benefit or in the case of severe self‐harm or harm to others (weak recommendation). Antipsychotics should be discontinued after cessation of behavioral disturbances and in patients in whom there are side effects (Good Practice statement). For treatment of epilepsy in individuals with dementia, newer anticonvulsants should be considered as first‐line therapy (Good Practice statement). Conclusion This GRADE‐based guideline offers recommendations on several important medical issues in patients with dementia, and thus adds important guidance for clinicians. For some issues, very little or no evidence was identified, highlighting the importance of further studies within these areas.

Rationale, Design, and Methodology of a Prospective Cohort Study for Coping with Behavioral and Psychological Symptoms of Dementia: The RECage Project1

“…In any case, medical treatment in SCU-Bs follows the current guidelines for the management of BPSD [13,[44][45][46]. Evidence from clinical trials of both non-pharmacological and pharmacological treatments, and from neurobiological studies, provides a range of management options that can be tailored to individual needs.…”

Cerebrovascular disease in patients with cognitive impairment: A white paper from the ESO dementia committee – A practical point of view with suggestions for the management of cerebrovascular diseases in memory clinics

“…Furthermore, cerebrovascular disease contributes to clinical symptoms that may aggravate or anticipate the clinical expression of underlying degenerative brain pathology There is a lack of evidence on the treatment of cerebrovascular disease in patients with CI. 4,5 Uncertainty about management of vascular risk factors and cerebrovascular disease in people affected by CI might lead to heterogeneity in the treatment of those patients. In addition, professionals from memory clinics may have less experience in the recognition and in the appropriate management of cerebrovascular disease.…”

Evaluating a Memory Clinic Using the RE-AIM Model. The Experience of the “Memory and Neuropsychiatry Clinic” in Hospital Del Salvador, Chile

“…MU also have a role in providing education and provide training about dementia to primary care, with the goal of improving diagnostic and treatment capacity in primary care settings ( 27 ). There have been several reports on the implementation of MU worldwide ( 28 – 30 ) with positive outcomes for patients and caregivers ( 31 ), establishing MU as an acceptable and effective form of dementia care ( 26 , 32 – 34 ).…”