Dementia: assessment, management and support: summary of updated NICE guidance

Pink, Joshua; O’Brien, John; Robinson, Louise; Longson, Damien

doi:10.1136/bmj.k2438

Cited by 95 publications

(92 citation statements)

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“…One already established drug that assesses the pathology of hyperexcitation is memantine, an N--methyl--D--aspartate (NMDA) antagonist. Memantine is recommended for the symptomatic treatment of severe AD as a mono-- and combination therapy with cholinesterase inhibitors and should be also considered as possible treatment in moderate AD in the current version of the UK National Institute for Health and Care Excellence (NICE) guidelines of dementia management (49). However, normally it is considered as an alternative or addition to cholinesterase inhibitors (49).…”

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confidence: 99%

“…Memantine is recommended for the symptomatic treatment of severe AD as a mono-- and combination therapy with cholinesterase inhibitors and should be also considered as possible treatment in moderate AD in the current version of the UK National Institute for Health and Care Excellence (NICE) guidelines of dementia management (49). However, normally it is considered as an alternative or addition to cholinesterase inhibitors (49). In contrast, memantine has shown in a current meta--analysis its efficacy to improve cognitive function and reduce behavioural disturbances in AD patients compared to placebo (50).…”

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confidence: 99%

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Linking molecular pathways and large-scale computational modeling to assess candidate disease mechanisms and pharmacodynamics in Alzheimer’s disease

Stefanovski

Triebkorn

Spiegler

et al. 2019

Preprint

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Introduction. While the prevalence of neurodegenerative diseases associated with dementia such as Alzheimer's disease (AD) increases, our knowledge on the underlying mechanisms, outcome predictors, or therapeutic targets is limited. In this work, we demonstrate how computational multi--scale brain modelling links phenomena of different scales and therefore identifies potential disease mechanisms leading the way to improved diagnostics and treatment. Methods. The Virtual Brain (TVB; thevirtualbrain.org) neuroinformatics platform allows standardized large--scale structural connectivity--based simulations of whole brain dynamics. We provide proof of concept for a novel approach that quantitatively links the effects of altered molecular pathways onto neuronal population dynamics. As a novelty, we connect chemical compounds measured with positron emission tomography (PET) with neural function in TVB addressing the phenomenon of hyperexcitability in AD related to the protein amyloid beta (Abeta). We construct personalized virtual brains based on individual PET derived distributions of Abeta in patients with mild cognitive impairment (MCI, N=8) and Alzheimer's Disease (AD, N=10) and in age--matched healthy controls (HC, N=15) using data from ADNI--3 data base (http://adni.lni.usc.edu). In the personalized virtual brains, individual Abeta burden modulates regional inhibition, leading to disinhibition and hyperexcitation with high Abeta loads. We analyze simulated regional neural activity and electroencephalograms (EEG). Results. Known empirical alterations of EEG in patients with AD compared to HCs were reproduced by simulations. The virtual AD group showed slower frequencies in simulated local field potentials and EEG compared to MCI and HC groups. The heterogeneity of the Abeta load is crucial for the virtual EEG slowing which is absent for control models with homogeneous Abeta distributions. Slowing phenomena primarily affect the network hubs, independent of the spatial distribution of Abeta. Modeling the N--methyl--D--aspartate (NMDA) receptor antagonism of memantine in local population models, reveals potential functional reversibility of the observed large--scale alterations (reflected by EEG slowing) in virtual AD brains. Discussion. We demonstrate how TVB enables the simulation of systems effects caused by pathogenetic molecular candidate mechanisms in human virtual brains.

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confidence: 99%

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confidence: 99%

Linking molecular pathways and large-scale computational modeling to assess candidate disease mechanisms and pharmacodynamics in Alzheimer’s disease

Stefanovski

Triebkorn

Spiegler

et al. 2019

Preprint

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“…In an attempt to reduce variation in the management of dementia and to improve quality of care, best practice guidelines including those of the National Institute for Health and Care Excellence and American Psychiatric Association now recommend medicine reviews at the time of diagnosis to reduced irrational medicine use in patients with dementia . These reviews also provide an opportunity to identify and rule out any reversible cause of confusion such as adverse effects of other medicines or untreated comorbidities .…”

Section: Introductionmentioning

confidence: 99%

“…14 In an attempt to reduce variation in the management of dementia and to improve quality of care, best practice guidelines including those of the National Institute for Health and Care Excellence and American Psychiatric Association now recommend medicine reviews at the time of diagnosis to reduced irrational medicine use in patients with dementia. [15][16][17][18][19] These reviews also provide an opportunity to identify and rule out any reversible cause of confusion such as adverse effects of other medicines or untreated comorbidities. 20 Recommendations on improving clinical outcomes have been updated; however, decisions on reducing potentially inappropriate combinations of medicines, such as concomitant use of dementia and anticholinergic medicines are challenging due to lack of clarity in guidelines for managing comorbidities in patients with dementia.…”

Section: Introductionmentioning

confidence: 99%

Anticholinergic medicines use among older adults before and after initiating dementia medicines

Narayan

Pearson

Litchfield

et al. 2019

Brit J Clinical Pharma

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Aims We investigated anticholinergic medicines use among older adults initiating dementia medicines. Methods We used Pharmaceutical Benefits Scheme dispensing claims to identify patients who initiated donepezil, rivastigmine, galantamine or memantine between 1 January 2013 and 30 June 2017 (after a period of ≥180 days with no dispensing of these medicines) and remained on therapy for ≥180 days ( n = 4393), and dispensed anticholinergic medicines in the 180 days before and after initiating dementia medicines. We further examined anticholinergic medicines prescribed by a prescriber other than the one initiating dementia medicines. Results One‐third of the study cohort (1439/4393) was exposed to anticholinergic medicines up to 180 days before or after initiating dementia medicines. Among patients exposed to anticholinergic medicines, 46% (659/1439) had the same medicine dispensed before and after initiating dementia medicines. The proportion of patients dispensed anticholinergic medicines increased by 2.5% (95% confidence interval [CI]: 1.3–3.7) after initiating dementia medicines. Antipsychotics use increased by 10.1% (95% CI: 7.6–12.7) after initiating dementia medicines; driven by increased risperidone use (7.3%, 95% CI: 5.3–9.3). Nearly half of patients dispensed anticholinergic medicines in the 180 days after (537/1133), were prescribed anticholinergic medicines by a prescriber other than the one initiating dementia medicines. Conclusion Use of anticholinergic medicines is common among patients initiating dementia medicines and this occurs against a backdrop of widespread campaigns to reduce irrational medicine combinations in this vulnerable population. Decisions about deprescribing medicines with questionable benefit among patients with dementia may be complicated by conflicting recommendations in prescribing guidelines.

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“…Alzheimer's disease (AD) is a progressive degenerative disease of the central nervous system. Individuals who have the moderate and severe forms of the disease often require a higher level of care by trained personnel (9,10) Most studies focussing on care of individuals with AD/ADRD and resource utilisation have been conducted in high resource settings (3,8). The resources needed to care for a patient with Alzheimer's disease depends on the stage of the disease.…”

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confidence: 99%

Enablers And Barriers To Utilisation Of Available Formal Support By Institutionalised Individuals With Alzheimer’s Disease And Related Dementias In Rural South Western Uganda: A Qualitative Descriptive Study

Niyonzima

Maling

Chemali

2019

Preprint

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Background: The world’s population is ageing resulting in a larger number of people living with dementia. Prevalence of dementia for persons aged above 60 years is expected to increase . There is paucity of information regarding formal support available for institutionalised individuals with AD/ADRD, enablers and barriers to its utilisation particularly South Western Uganda. Therefore this study, filling this knowledge gap, sought to assess formal support available for individuals with AD/ADRD, enablers and barriers to its utilisation in rural communities in South Western Uganda Methods: This study was conducted in two nongovernmental community based facilities for the elderly in South Western Uganda employing a qualitative cross sectional study design. Purposive sampling was used to recruit caretakers of individuals with Alzheimer’s disease and related dementias. A total of 28 in depth interviews and 6 key informant interviews were conducted. Results: Three arching themes emerged: 1) Formal support services available, 2) Enablers and 3) Barriers to the utilisation of the formal support services in institutionalised patients with AD/ADRD in rural communities in South Western Uganda. Conclusions: These findings highlight the importance of formal care in the long-term care of individuals with AD/ADRD. There is a dire need to equip caretakers involved in the care of patients with AD/ADRD with the required skill set and include formal support services in the mainstream primary health care to make the services accessible.

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Dementia: assessment, management and support: summary of updated NICE guidance

Cited by 95 publications

References 0 publications

Linking molecular pathways and large-scale computational modeling to assess candidate disease mechanisms and pharmacodynamics in Alzheimer’s disease

Linking molecular pathways and large-scale computational modeling to assess candidate disease mechanisms and pharmacodynamics in Alzheimer’s disease

Anticholinergic medicines use among older adults before and after initiating dementia medicines

Enablers And Barriers To Utilisation Of Available Formal Support By Institutionalised Individuals With Alzheimer’s Disease And Related Dementias In Rural South Western Uganda: A Qualitative Descriptive Study

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