Ministry of Health Clinical Practice Guidelines: Dementia

K, Nagaendran; Lh, Chen; Ms, Chong; Ev, Chua; Ck, Goh; J, Kua; T, Lee; Lw, Shiong; Ar, Marziyana; Cc, Ng; Ll, Ng; Seow, Dennis; Yy, Sitoh; Lk, Yap; Yeo, Darren C. J.; Y, Yeo

doi:10.11622/smedj.2013112

Cited by 12 publications

(4 citation statements)

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“…Three pointed out that RCT evidence of the long-term benefits of ChEI therapy, particularly among those with severe disease, was limited. (22, 30, 32) Another (25) suggested that the evidence was insufficient to determine the optimal duration of therapy, but that initial benefits (either improvement or stabilization) should be expected within three months. Two (23, 33) warned against exclusively relying on MMSE score and recommended considering functional and behavioral assessment, in conjunction with the family/caregiver assessment of the patient’s condition.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Practice Guidelines and Recommendations for Discontinuation of Cholinesterase Inhibitors in Dementia

Renn

Asghar-Ali

Thielke

et al. 2018

The American Journal of Geriatric Psychiatry

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Cholinesterase inhibitors (ChEIs) are the primary pharmacological treatment for symptom management of Alzheimer disease (AD), but they carry known risks during long-term use, and do not guarantee clinical effects over time. The balance of risks and benefits may warrant discontinuation at different points during the disease course. Indeed, although there is limited scientific study of deprescribing ChEIs, clinicians routinely face practical decisions about whether to continue or stop medications. This review examined published practice recommendations for discontinuation of ChEIs in AD. To characterize the scientific basis for recommendations, we first summarized randomized controlled trials of ChEI discontinuation. We then identified practice guidelines by professional societies and in textbooks and classified them according to 1) whether they made a recommendation about discontinuation, 2) what the recommendation was, and 3) the proposed grounds for discontinuation. There was no consensus in guidelines and textbooks about discontinuation. Most recommended individualized discontinuation decisions, but there was essentially no agreement about what findings or situations would warrant discontinuation, or even about what domains to consider in this process. The only relevant domain identified by most guidelines and textbooks was a lack of response or a loss of effectiveness, both of which can be difficult to ascertain in the course of a progressive condition. Well-designed, long-term studies of discontinuation have not been conducted; such evidence is needed to provide a scientific basis for practice guidelines. It seems reasonable to apply an individualized approach to discontinuation while engaging patients and families in treatment decisions. .

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Section: Resultsmentioning

confidence: 99%

A Systematic Review of Practice Guidelines and Recommendations for Discontinuation of Cholinesterase Inhibitors in Dementia

Renn

Asghar-Ali

Thielke

et al. 2018

The American Journal of Geriatric Psychiatry

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“…Second, the participants might not be representative of the entire target population at risk of cognitive impairment (older persons aged≥65 years) [26], since recruitment was carried out only at one location with multiple exclusion criteria. Furthermore, the study population was classified solely on the basis of the MoCA scores, which is a screening tool and not considered diagnostic of cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

Virtual Reality for Screening of Cognitive Function in Older Persons: Comparative Study

et al. 2019

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Background The prevalence of dementia, which presents as cognitive decline in one or more cognitive domains affecting function, is increasing worldwide. Traditional cognitive screening tools for dementia have their limitations, with emphasis on memory and, to a lesser extent, on the cognitive domain of executive function. The use of virtual reality (VR) in screening for cognitive function in older persons is promising, but evidence for its use is sparse. Objective The primary aim was to examine the feasibility and acceptability of using VR to screen for cognitive impairment in older persons in a primary care setting. The secondary aim was to assess the module’s ability to discriminate between cognitively intact and cognitively impaired participants. Methods A comparative study was conducted at a public primary care clinic in Singapore, where persons aged 65-85 years were recruited based on a cut-off score of 26 on the Montreal Cognitive Assessment (MoCA) scale. They participated in a VR module for assessment of their learning and memory, perceptual-motor function, and executive function. Each participant was evaluated by the total performance score (range: 0-700) upon completion of the study. A questionnaire was also administered to assess their perception of and attitude toward VR. Results A total of 37 participants in Group 1 (cognitively intact; MoCA score≥26) and 23 participants in Group 2 (cognitively impaired; MoCA score<26) were assessed. The mean time to completion of the study was 19.1 (SD 3.6) minutes in Group 1 and 20.4 (3.4) minutes in Group 2. Mean feedback scores ranged from 3.80 to 4.48 (max=5) in favor of VR. The total performance score in Group 1 (552.0, SD 57.2) was higher than that in Group 2 (476.1, SD 61.9; P<.001) and exhibited a moderate positive correlation with scores from other cognitive screening tools: Abbreviated Mental Test (0.312), Mini-Mental State Examination (0.373), and MoCA (0.427). A receiver operating characteristic curve analysis for the relationship between the total performance score and the presence of cognitive impairment showed an area under curve of 0.821 (95% CI 0.714-0.928). Conclusions We demonstrated the feasibility of using a VR-based screening tool for cognitive function in older persons in primary care, who were largely in favor of this tool.

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“…Evidence-based clinical guidelines for dementia care recommend a holistic approach to ameliorate disease progression and improve QOL of PWD [4, 5]. These include interdisciplinary case management targeting PWDs and their caregivers, community-based and home-based services, and psychoeducational and care transition programmes [6].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Outcomes of a Hospital-to-Community Model of Integrated Care for Dementia

Yap

Nicholas

et al. 2020

Dement Geriatr Cogn Disord

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Introduction: Living with dementia is challenging for persons with dementia (PWDs) and their families. Although multi-component intervention, underscored by the ethos of person-centred care, has been shown to maintain quality of life (QOL) in PWDs and caregivers, a lack of service integration can hinder effectiveness. Methods: CARITAS, an integrated care initiative provided through a hospital-community care partnership, endeavours to provide person-centred dementia care through ambulatory clinic consults, case management, patient and caregiver engagement, and support. We evaluated CARITAS’ clinical outcomes and cost-effectiveness with a naturalistic cross-sectional within-subject design. We assessed patients’ function, QOL, and behavioural problems post-intervention. We estimated CARITAS’ cost-effectiveness from a patient’s perspective, benchmarking it against other dementia treatments and Singapore’s Gross Domestic Product (GDP) per capita. Results: CARITAS care significantly improved health utility (p < 0.001), reduced caregiver burden (p < 0.001), and improved PWDs’ behavioural problems (p < 0.001) related to “memory” (p < 0.001), “disruption” (p = 0.017), and “depression” (p < 0.001). CARITAS’ benefits (dRMBPC = 0.357, dEQ5D index = 0.328, dZBI = 0.361) were comparable to those of other pharmacological and non-pharmacological interventions for dementia. CARITAS costs SG$133,056.69 per quality-adjusted life years gain, yielding an incremental cost-effectiveness ratio of 1.31 and 1.49 against the cost of donepezil in patients with mild Alzheimer’s disease and Singapore’s GDP per capita in 2019, respectively, falling within the cost-effectiveness threshold of 1.0–3.0. Discussion: CARITAS integrated dementia care is a cost-effective intervention that showed promising outcomes for PWDs and their caregivers.

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Ministry of Health Clinical Practice Guidelines: Dementia

Cited by 12 publications

References 0 publications

A Systematic Review of Practice Guidelines and Recommendations for Discontinuation of Cholinesterase Inhibitors in Dementia

A Systematic Review of Practice Guidelines and Recommendations for Discontinuation of Cholinesterase Inhibitors in Dementia

Virtual Reality for Screening of Cognitive Function in Older Persons: Comparative Study

Evaluating the Outcomes of a Hospital-to-Community Model of Integrated Care for Dementia

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