Efficacy and safety of cognitive enhancers for patients with mild cognitive impairment: a systematic review and meta-analysis

Tricco, Andrea C.; Soobiah, Charlene; Berliner, Shirra; Ho, Joanne; Ng, Carmen; Ashoor, Huda; Chen, Maggie H; Hemmelgarn, Brenda R.; Straus, Sharon E.

doi:10.1503/cmaj.130451

Cited by 176 publications

(129 citation statements)

References 41 publications

Supporting

Mentioning

117

Contrasting

Unclassified

Order By: Relevance

“…The task force workgroup selected outcomes important to patients and the scales used to measure such outcomes from those selected and prioritized by Canadian clinicians and policy-makers. 14 10 The harms for treatment were identified by the guideline working group, which included serious adverse events (i.e., hospital admission or death) and psychosocial harms (e.g., lack of independence, stress, depression). 10 Studies that did not use the measures of cognition prioritized by the Canadian clinicians and policy-makers 14 were excluded from the systematic review.…”

Section: Methodsmentioning

confidence: 99%

“…The MMSE and the MoCA tools are commonly used by Canadian clinicians in clinical practice. 14 Treatments include medications such as cholinesterase inhibitors (i.e., donepezil, rivastigmine and galantamine), dietary supplements and vitamins, and nonpharmacologic interventions such as exercise, and cognitive training and rehabilitation. 10 Provincial payment for the medications used in primary care practice is often linked to cognitive assessment scores measured by the screening instruments.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Recommendations on screening for cognitive impairment in older adults

Pottie

Rahal

Jaramillo

et al. 2015

CMAJ

View full text Add to dashboard Cite

• Practitioners should consider cognitive assessment for patients with signs and symptoms of impairment or when family members or patients express concerns about potential cognitive decline. cognitive impairment (scores of 10-17) and severe impairment (scores less than 10). Key points 13The ADAS-cog is a cognitive testing instrument not normally used in practice but often used in research studies. It consists of 11 tasks measuring disturbances of memory, language, praxis (i.e., application or use of specific knowledge or skills such as drawing geometric figures or fitting a page into an envelope), attention and other cognitive abilities. 9 A change in the ADAS-cog score of 4 points is considered by many clinical experts to represent a clinically important change. The MMSE and the MoCA tools are commonly used by Canadian clinicians in clinical practice.14 Treatments include medications such as cholinesterase inhibitors (i.e., donepezil, rivastigmine and galantamine), dietary supplements and vitamins, and nonpharmacologic interventions such as exercise, and cognitive training and rehabilitation. 10 Provincial payment for the medications used in primary care practice is often linked to cognitive assessment scores measured by the screening instruments.The objective of this guideline, which updates the 2001 Canadian Task Force on Preventive Health Care recommendations, 15 is to provide evidence-based recommendations on screening for cognitive impairment in adults. The guideline focuses on screening asymptomatic adults. This recommendation does not apply to men and women who are concerned about their own cognitive performance (i.e., patients who report cognitive changes to their clinician or others) or who are suspected of having mild cognitive impairment or dementia by clinicians or nonclinicians (i.e., caregivers, family or friends) and who have symptoms suggestive of mild cognitive impairment or dementia (e.g., loss of memory, language, attention, visuospatial or executive functioning, or behavioural or psychological symptoms that may mildly or substantially affect a patient's day-to-day life or usual activities). MethodsThe Canadian Task Force on Preventive Health Care is an independent panel of volunteer clinicians and methodologists that makes recommendations about clinical manoeuvres aimed at primary and secondary prevention (www.canadian taskforce.ca). The development of these recommendations was led by a workgroup of eight members of the task force and scientific staff at the Public Health Agency of Canada. The task force established this topic as a priority based on the potential to decrease inconsistencies in screening in primary care practice and a need to determine whether benefits of screening outweigh harms.The US Preventive Services Task Force recently published a systematic review on screening and treatment for cognitive impairment.11 Initially, the Canadian task force updated the US task force review, assessing the effects of screening for cognitive impairment on health outcomes. 9 The Evidence Revie...

show abstract

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Recommendations on screening for cognitive impairment in older adults

Pottie

Rahal

Jaramillo

et al. 2015

CMAJ

View full text Add to dashboard Cite

show abstract

“…24 Acetylcholinesterase inhibitors should not be prescribed for people with mild cognitive impairment. 25 If people with dementia cannot express their needs through communication, they may communicate through their actions and behaviour. The guidelines recommend the need to understand the person and symptoms via a comprehensive assessment and analysis of the behaviour (eg, antecedent [triggers], behaviour description and consequence [ABC approach]).…”

Section: Changes In Managementmentioning

confidence: 99%

Clinical practice guidelines for dementia in Australia

Laver

Cumming

Dyer

et al. 2016

Medical Journal of Australia

104

115

View full text Add to dashboard Cite

“…The burden of dementia, both of the disease itself and financially, is great on individuals, families, and public health services. Furthermore, the effectiveness of current pharmacologic treatments is inconsistent (3,4). Despite the fact that the causes of dementia are multifactorial, there is a growing body of evidence showing that modifiable risk factors such as cardiometabolic disease and lifestyle play important roles; thus, nutrition poses an interesting avenue for investigation (5,6).…”

Section: Introductionmentioning

confidence: 99%

Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review of the Evidence

Petersson

Philippou

2016

Advances in Nutrition

347

212

View full text Add to dashboard Cite

A growing body of evidence suggests that adherence to the Mediterranean diet (MD) may protect against cognitive decline and dementia. Many epidemiologic studies and several randomized controlled trials (RCTs) have found positive effects of the MD on cognitive function, but findings remain inconsistent. The aim of this systematic review was to provide an update on the current knowledge of the effects of the MD on cognitive function, cognitive impairment, Alzheimer disease (AD), and all-type dementia. Five databases were searched-PubMed, Embase, CINAHL, CENTRAL, and PsycINFO (1806 to 25 May 2015)-with the use of prespecified criteria. Human studies that were published in English without any restriction on study type, population assessed, intervention period, follow-up time, or publication date, and that examined the association between adherence to the MD and cognitive function or dementia symptoms (as measured by cognitive function tests), were included. Only primary publication types were included. Thirty-two studies from 25 unique cohorts, including 5 RCTs and 27 observational studies, met the inclusion criteria. The majority of studies showed that the MD was associated with improved cognitive function, a decreased risk of cognitive impairment or decreased risk of dementia, or AD. Three studies found no correlation between the MD and AD, 3 further studies found no association between the MD and cognitive impairment, and 5 studies found no association between the MD and cognitive function. There was large heterogeneity, and studies differed with regard to quality. Based on the findings and the limitations in study design, we conclude that adherence to the MD is associated with better cognitive performance. However, it should be noted that the majority of findings come from epidemiologic studies that provide evidence for a correlation between the MD and cognition but not for a cause-and-effect relation. More controlled trials are required to establish a causational relation. Adv Nutr 2016;7:889-904.

show abstract

Efficacy and safety of cognitive enhancers for patients with mild cognitive impairment: a systematic review and meta-analysis

Cited by 176 publications

References 41 publications

Recommendations on screening for cognitive impairment in older adults

Recommendations on screening for cognitive impairment in older adults

Clinical practice guidelines for dementia in Australia

Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review of the Evidence

Contact Info

Product

Resources

About