Evidence-based Dementia Practice

by Qizilbash, Nawab; Schneider, Lon S.; Brodaty, Henry; Tariot, Pierre; Kaye, Jeffrey; Chui, Helena; Erkinjuntti, Timo; Khachaturian, Zaven S.

• ISBN13: 9780632052967
• ISBN10: 0632052961
• Edition: 1st
• Format: Hardcover
• Copyright: 2002-05-06
• Publisher: Wiley-Blackwell

Summary

The era of therapeutic nihilism in dementia has ended, with the emergence of agents for symptomatic treatment, those that delay the course of the disease or prevent the onset of dementia, and new methods to manage symptoms. With the expansion of therapies, there is a clear danger of being overwhelmed by the volume of data. This book is designed to collect this information, distil what is relevant and reliable, and present it in a format that is useful to clinicians who manage and treat people with dementia. The book is designed to bring together the latest, best and practical evidence on all aspects of management, from diagnosis and therapy to social and ethical considerations. The editors are all dynamic clinicians involved in the care of patients with dementia and the evaluation of therapies. Two of the editors are the leaders of the Cochrane Collaboration for the examination of therapies for dementia. There are no other books that take such a practical and problem-oriented or approach to the diagnosis and management of dementia. Furthermore none but this can be described as truely evidence-based.

Author Biography

Nawab Qizilbash is the editor of Evidence-based Dementia Practice, published by Wiley.

Lon S. Schneider is the editor of Evidence-based Dementia Practice, published by Wiley.

Henry Brodaty is the editor of Evidence-based Dementia Practice, published by Wiley.

Pierre Tariot is the editor of Evidence-based Dementia Practice, published by Wiley.

Jeffrey Kaye is the editor of Evidence-based Dementia Practice, published by Wiley.

Helena Chui is the editor of Evidence-based Dementia Practice, published by Wiley.

Timo Erkinjuntti is the editor of Evidence-based Dementia Practice, published by Wiley.

Table of Contents

List of Contributors	xi
Foreword	xv
Preface	xix
Evidence-based Methods in Dementia
Nawab Quizilbash
Lon S. Schneider
Introduction	3	(3)
Nawab Qizilbash
Finding the Evidence	6	(6)
Nawab Qizilbash
Critical Appraisal	12	(2)
Nawab Qizilbash
Evidence-based Etiology and Harm	14	(4)
Nawab Qizilbash
Evidence-based Diagnosis	18	(8)
Nawab Qizilbash
Evidence-based Interventions	26	(5)
Nawab Qizilbash
Evidence-based Interventions	31	(11)
Nawab Qizilbash
Evidence-based Systematic Reviews and Meta-analyses	42	(18)
Nawab Qizilbash
Evidence-based Guidelines	60	(4)
Nawab Qizilbash
Evidence-based Economic Evaluation	64	(7)
Nawab Qizilbash
Accessing and Using the Best Evidence Efficiently in Dementia	71	(3)
Nawab Qizilbash
Evidence-based Audit: Evaluating Implementation	74	(7)
Nawab Qizilbash
Diagnosis
Helena Chui
Introduction	81	(5)
Helena Chui
Practice Guidelines	86	(6)
Helena Chui
Reaching a Diagnosis of Dementia	92	(14)
Helena Chui
Neuropsychological Assessment	92	(9)
Mary C. Tierney
Diagnostic Instruments to Assess Functional Impairment	101	(5)
Serge Gauthier
Reaching a Diagnosis of a Dementia Subtype	106	(88)
Helena Chui
Clinical Criteria for Dementia Subtypes	106	(13)
Helena Chui
Ae-Young Lee
Clinical History and Neurological Signs	119	(5)
Helena Chui
Behavioral Characteristics in Diagnosis	124	(5)
Jeffrey Cummings
Neuropsychological Assessment	129	(4)
Mary C. Tierney
Genetic Markers in Differential Diagnosis	133	(5)
Haydeh Payami
Utility of CT Scanning in Diagnosing Dementia	138	(16)
Jaime Diaz-Guzman
J. Maria Millan
David G. Munoz
Felix Bermejo
MRI of the Medical Temporal Lobe for the Diagnosis of Alzheimer's Disease	154	(8)
Lisette Bosscher
Philip Scheltens
Functional Imaging in Dementia	162	(8)
William Jagust
Helena Chui
Ae-Young Lee
EEG as a Diagnostic Tool in Dementia	170	(5)
Hilkka Soininen
Juhani Partanen
Cerebrospinal Fluid Biomarkers	175	(19)
Kaj Blennow
Anders Wallin
Conclusions	194	(5)
Helena Chui
Background Facts
Timo Erkinjuntti
Historical Evolution of the Concept of Dementia: a Systematic Review From 2000 BC to 2000 AD	199	(29)
Gustavo C. Roman
Alzheimer's Disease	228	(32)
David Knopman
Karen Ritchie
Catherine Polge
Irina Alafuzoff
Hikka Soininen
Preamble	228	(1)
David Knopman
Diagnostic Considerations	228	(6)
David Knopman
Clinical Picture	234	(3)
David Knopman
Diagnostic Tools	237	(1)
David Knopman
Epidemiology of the Dementias and Alzheimer's Disease	238	(2)
Karen Ritchie
Risk Factors and Mortality	240	(1)
Karen Ritchie
Prevalence and Incidence	241	(2)
Karen Ritchie
Catherine Polge
Calculating Burden	243	(1)
Karen Ritchie
Neuropathology and Ethiopathogenesis of Alzheimer's Disease	244	(16)
Irina Alafuzoff
Hilkka Soininen
Vascular Dementia	260	(28)
Didier Leys
Elisabet Englund
Timo Erkinjuntti
Introduction	260	(1)
Diagnosis	260	(2)
Diagnostic Criteria	262	(3)
Epidemiology	265	(3)
Determinants of Vascular Dementia	268	(5)
Clinical Patterns	273	(2)
Heterogeneity of Vascular Dementia	275	(4)
Differential Diagnosis	279	(9)
Lewy Body Dementia	288	(9)
Douglas Galasko
Introduction	288	(1)
Definition and Diagnostic Criteria	289	(1)
Clinical Picture	290	(2)
Incidence and Prevalence	292	(1)
Etiology	293	(1)
Prognosis	294	(1)
Accuracy of Diagnostic Criteria	294	(3)
Frontotemporal Lobar Atrophies: The Pick Complex	297	(15)
David G. Munoz
Andrew Kertesz
Introduction	297	(1)
Clinical Features	298	(2)
Basic Biology of Tau	300	(1)
Structural Substrates	300	(3)
Alterations in Tau Proteins and Gene	303	(1)
Pathogenic Mechanisms in Pick Complex	304	(1)
Incidence and Prevalence	305	(1)
Diagnostic Tests	305	(1)
Diagnostic Criteria and Differential Diagnosis	306	(1)
Clinical Vignette	307	(5)
Other Important Dementias	312	(18)
Juha O. Rinne
Introduction	312	(1)
Parkinson's Disease	312	(4)
Huntington's Disease	316	(2)
Progressive Supranuclear Palsy	318	(1)
Multiple System Atrophy	319	(1)
Corticobasal Degeneration	319	(1)
Conclusions	320	(1)
Infectious Dementias	320	(10)
Irina Elovaara
Irina Alafuzoff
Reversible or Arrestable Dementias	330	(11)
Lars-Olof Wahlund
Hans Basun
Gunhild Waldemar
Introduction	330	(2)
Normal Pressure Hydrocephalus and Intracranial Space-occupying Lesions	332	(1)
Depression	333	(1)
Drugs	334	(1)
Thyroid	335	(1)
Vitamin B12	336	(1)
Folate	336	(1)
Other Potentially Reversible Conditions	337	(1)
Summary	338	(3)
Mild Cognitive Impairment	341	(16)
Alan Kluger
James Golomb
Steven H. Ferris
Introduction	341	(1)
Definition and Diagnostic Criteria	342	(1)
Clinical Picture	343	(1)
Diagnostic Tools	344	(1)
Incidence, Prevalence and Burden	345	(1)
Epidemiologic Risk Factors	346	(1)
Prognosis	346	(2)
Pathology/Pathogenetic Etiology	348	(2)
Likely Subtypes of MCI	350	(1)
Treatment of MCI	351	(6)
Overview of Treatment and Management
Jeffrey Kaye
Lon S. Schneider
Nawab Quizilbash
Aims of Treatment	357	(2)
Jeffrey Kaye
Criteria for Clinical Decisions	359	(6)
Jeffrey Kaye
What is the Diagnosis?	359	(1)
What are the Patient's Principal Problems?	360	(1)
What is the Prognosis?	360	(2)
What are the Patient and Family Expectations?	362	(1)
What is the Likelihood of Treatment Benefit?	363	(2)
Clinical Decisions in Practice	365	(8)
Jeffrey Kaye
Rationale for Treatment---Assessing the Evidence	365	(1)
From Groups to Individuals	366	(1)
The Application of Specific Treatments for Dementia	367	(1)
Caregivers in the Therapeutics of Dementia	368	(1)
Treatment of Mood Changes and Depression	368	(1)
Treatment of Behavioral Changes	369	(1)
Cognitive Therapies	370	(1)
Preventative Therapies	370	(1)
Principles of Administration	371	(1)
Monitoring Treatment Effects	371	(2)
Delivering an Integrated Treatment Plan	373	(3)
Jeffrey Kaye
Establishing a Knowledge Base and Providing Education	373	(1)
Addressing Social and Environmental Needs	373	(1)
Health Maintenance	374	(1)
Behavioral Management	374	(1)
Neurological Management	374	(1)
Cognitive Function	375	(1)
Prevention	375	(1)
What is the Evidence that a Dementia Treatment Works?	376	(52)
Criteria Used by Drug Regulatory Authorities	376	(11)
Paul Leber
Criteria Used by Purchasers of Health Care services	387	(18)
David Millson
David Jolley
Harry Ward
Dementia Trials for Cognitive Symptoms and Modification of Prognosis: Past, Present and Future	405	(12)
Nawab Qizilbash
Lon S. Schneider
Individualizing Symptomatic Therapy: n-of-1 Trials	417	(11)
Nawab Qizilbash
Non-pharmacological Techniques	428	(19)
Robert T. Woods
Introduction	428	(2)
Reality Orientation	430	(3)
Reminiscence Therapy	433	(1)
Validation Therapy	434	(1)
Memory Training	435	(1)
Stimulation	436	(1)
Cognitive-behavioral Therapy	437	(1)
Behavioral Approaches	438	(3)
Conclusion and Integration	441	(1)
Summary of Key Points	442	(5)
Drugs in Development and Experimental Approaches	447	(14)
Murat Emre
Therapies for Cognitive Symptoms, Disease Modification and Prevention
Jeffrey Kaye
Lon S. Schneider
Nawab Qizilbash
Introduction to Specific Therapies for Cognitive Symptoms or Modifying Disease Prognosis	461	(6)
Nawab Qizilbash
Treatment of Alzheimer's Disease (With or Without Cerebrovascular Disease)	467	(122)
Lon S. Schneider
Introduction	467	(1)
Nawab Qizilbash
Acetyl-L-carnitine	468	(3)
Mary Sano
Fadi Massoud
Antioxidant Vitamins	471	(2)
Jeffrey Kaye
Donepezil in the Treatment of Alzheimer's Disease	473	(11)
Lon S. Schneider
Galantamine	484	(9)
Lon S. Schneider
Jason T. Olin
Metrifonate	493	(6)
Lon S. Schneider
Rivastigmine	499	(10)
Lon S. Schneider
Tacrine	509	(7)
Nawab Qizilbash
D-Cycloserine	516	(2)
Knut Laake
Anne Rita Øksengaard
Ginkgo Biloba	518	(5)
Barry S. Oken
Estrogen	523	(3)
Fadi Massoud
Kristine Yaffe
Mary Sano
Hydergine	526	(4)
Lon S. Schneider
Jason T. Olin
Idebenone	530	(5)
Kentaro Hashimoto
Nicotine	535	(2)
Jesus Lopez-Arrieta
Nimodipine	537	(4)
Jesus Lopez-Arrieta
Non-steroidal Anti-inflammatory Drugs	541	(5)
John C.S. Breitner
Piracetam	546	(2)
Leon Flicker
Propentofylline	548	(5)
Kenneth Rockwood
Selegiline in the Treatment of Alzheimer's Disease	553	(4)
Mary Sano
Fadi Maussoud
Thiamine	557	(3)
Jose Luis Rodriquez-Martin
Summary, Practical Recommendations and Opinions on Therapies for Cognitive Symptoms and Prognosis Modification	560	(29)
Nawab Qizilbash
Lon S. Schneider
Treatment of Vascular Dementia	589	(19)
Introduction	589	(1)
Jeffrey Kaye
Antioxidants	589	(1)
Nawab Qizilbash
Antithrombotics	590	(3)
Helmi L. Lutsep
Blood Pressure Reduction	593	(3)
Nawab Qizilbash
CDP-choline	596	(3)
Mario Fioravanti
Ginkgo Biloba	599	(1)
Nawab Qizilbash
Hydergine	599	(1)
Nawab Qizilbash
Nimodipine	600	(1)
Nawab Qizilbash
Pentoxifylline	600	(3)
Leon Flicker
Piracetam	603	(1)
Nawab Qizilbash
Propentofylline	603	(1)
Nawab Qizilbash
Summary, Practical Recommendations and Conclusions	603	(5)
Jeffrey Kaye
Treatment of Lewy Body Dementia	608	(7)
E. Jane Byrne
Treatment of Reversible or Arrestable Dementias	615	(24)
Perminder Sachdev
Julian Trollor
Jeffrey C.L. Looi
Introduction	615	(1)
Infections of the Central Nervous System	616	(4)
Traumatic Brain Injury and Dementia Pugilistica	620	(1)
Alcohol-related Dementia	620	(1)
Cerebral Hypoxia/Anoxia	621	(6)
Tumors and Malignancy	627	(1)
Vitamin Deficiencies	628	(1)
Metabolic Causes	628	(2)
Chronic Disease	630	(1)
Conclusion	631	(8)
Treatment of Age-associated Memory Impairment	639	(15)
Keith Wesnes
Tony Ward
Prevention of Dementia	654	(15)
Anthony F. Jorm
Treating Non-cognitive Problems
Pierre Tariot
A Problem-oriented Approach to Common Psychiatric Problems	669	(2)
Pierre Tariot
Introduction	671	(4)
Pierre Tariot
Classes of Psychotropics---Overview of Evidence from Clinical Trials	675	(20)
Conventional Antipsychotics	675	(2)
Brian A. Lawlor
Gregory Swanwick
Atypical Antipsychotics	677	(1)
Brian A. Lawlor
Gregory Swanwick
Anxiolytics	678	(4)
Louise Carrier
Anticonvulsants	682	(4)
Pierre Tariot
Other Classes of Psychotropics in Dementia	686	(9)
Pierre Tariot
Problems	695	(25)
Depressive Features in Dementia	695	(3)
D.P. Devanand
Gregory H. Pelton
Steven P. Roose
Psychosis	698	(7)
Brian A. Lawlor
Gregory Swanwick
Agitation	705	(2)
Pierre Tariot
Hypersexuality	707	(4)
Joan M. Swearer
Sleep Disturbance	711	(9)
Joan M. Swearer
Summary, Practical Recommendations and Opinions	720	(3)
Pierre Tariot
A Problem-oriented Approach to Common Medical Problems	723	(2)
Nawab Qizilbash
Jesus Lopez-Arrieta
Common Medical Problems	725	(22)
Introduction	725	(3)
Nawab Qizilbash
Jesus Lopez-Arrieta
Delirium	728	(2)
Nawab Qizilbash
Jesus Lopez-Arrieta
Seizures	730	(1)
Nawab Qizilbash
Jesus Lopez-Arrieta
Mobility, Falls and Fractures	731	(2)
Nawab Qizilbash
Jesus Lopez-Arrieta
Feeding Problems and Weight Loss	733	(1)
Nawab Qizilbash
Jesus Lopez-Arrieta
Incontinence	734	(5)
Mark Castleden
Stephen Evans
Death	739	(8)
Nawab Qizilbash
Jesus Lopez-Arrieta
Social, Ethical and Health Services Issues
Henry Brodaty
Social and Ethical Issues	747	(8)
Stephen G. Post
Respect and Care for the Person with Dementia	747	(1)
Diagnostic Truth-telling and Precedent Autonomy	748	(1)
Research Ethics and Informed Consent	748	(2)
Quality of Life, Morbidity Protraction, and Cognitive Enhancing Drugs	750	(1)
Dying Well in Advanced Dementia: The Ethics of Nutrition and Hydration	751	(4)
Driving	755	(9)
Desmond O'Neill
Care-giver Interventions	764	(31)
Alisa Green
Henry Brodaty
Genetic Counseling	795	(6)
A. Dessa Sadovnick
Nursing Home Care for Patients with Dementia	801	(10)
Ira R. Katz
Catherine J. Datto
Melissa Katz-Snellgrove
Organization of Care	811	(17)
Michael S. Dennis
James Lindesay
Introduction	811	(1)
Determining Population Needs, and Service Planning	812	(1)
Individual Components of a Dementia Service	813	(11)
Monitoring and Evaluating Services	824	(1)
Conclusions and Future Research Priorities	825	(3)
Memory Clinics---a Guide to Implementation and Evaluation	828	(16)
Roger Bullock
Nawab Qizilbash
Background	828	(1)
Summary of Rationale for Establishing a Memory Clinic	829	(1)
Setting up a Memory Clinic	829	(8)
The Future Development of the Memory Clinic	837	(7)
Health Economics	844	(11)
Alastair M. Gray
Introduction	844	(1)
Methods	845	(1)
Cost Analyses and Cost-of-Illness Studies	845	(3)
Diagnosis	848	(1)
Evaluations of Care and Treatment	849	(1)
Economic Evaluation of Drug Interventions	850	(2)
Conclusions	852	(3)
Appendices
Appendix I: Diagnostic Criteria for Common Dementias	855	(4)
Nawab Qizilbash
Appendix II: Dementia Rating Scales	859	(11)
Roger Bullock
Appendix III: National Alzheimer's Disease and Dementia Associations and Societies	870	(5)
Nawab Qizilbash
Abbreviations	875	(4)
Index	879