Evidence-based Dementia Practice (eBook)

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.

Evidence-based Dementia Practice 3
Contents 5
List of Contributors 13
Foreword 17
Preface 21
Section I Evidence-based Methods in Dementia 25
I.1 Introduction 27
I.2 Finding the Evidence 30
I.3 Critical Appraisal 36
I.4 Evidence-based Etiology and Harm 38
I.5 Evidence-based Diagnosis 42
I.6 Evidence-based Prognosis 50
I.7 Evidence-based Interventions 55
I.8 Evidence-based Systematic Reviews and Meta-analyses 66
I.9 Evidence-based Guidelines 84
I.10 Evidence-based Economic Evaluation 88
I.11 Accessing and Using the Best Evidence Efficiently in Dementia 95
I.12 Evidence-based Audit: Evaluating Implementation 98
Section II Diagnosis 103
II.1 Introduction 105
II.2 Practice Guidelines 110
II.3 Reaching a Diagnosis of Dementia 116
II.3.1 Neuropsychological Assessment 116
II.3.2 Diagnostic Instruments to Assess Functional Impairment 125
II.4 Reaching a Diagnosis of a Dementia Subtype 130
II.4.1 Clinical Criteria for Dementia Subtypes 130
II.4.2 Clinical History and Neurological Signs 143
II.4.3 Behavioral Characteristics in Diagnosis 148
II.4.4 Neuropsychological Assessment 153
II.4.5 Genetic Markers in Differential Diagnosis 157
II.4.6 Utility of CT Scanning in Diagnosing Dementia 162
II.4.7 MRI of the Medial Temporal Lobe for the Diagnosis of Alzheimer’s Disease 178
II.4.8 Functional Imaging in Dementia 186
II.4.9 EEG as a Diagnostic Tool in Dementia 194
II.4.10 Cerebrospinal Fluid Biomarkers 199
II.5 Conclusions 218
Section III Background Facts 221
III.1 Historical Evolution of the Concept of Dementia: a Systematic Review From 2000 BC to AD 2000 223
III.2 Alzheimer’s Disease 252
III.2.1 Preamble 252
III.2.2 Diagnostic Considerations 253
III.2.3 Clinical Picture 258
III.2.4 Diagnostic Tools 261
III.2.5 Epidemiology of the Dementias and Alzheimer’s Disease 262
III.2.6 Risk Factors and Mortality 264
III.2.7 Prevalence and Incidence 265
III.2.8 Calculating Burden 267
III.2.9 Neuropathology and Ethiopathogenesis of Alzheimer’s Disease 268
III.3 Vascular Dementia 284
III.3.1 Introduction 284
III.3.2 Diagnosis 284
III.3.3 Diagnostic Criteria 286
III.3.4 Epidemiology 289
III.3.5 Determinants of Vascular Dementia 292
III.3.6 Clinical Patterns 297
III.3.7 Heterogeneity of Vascular Dementia 299
III.3.8 Differential Diagnosis 303
III.4 Lewy Body Dementia 312
III.4.1 Introduction 312
III.4.2 Definition and Diagnostic Criteria 313
III.4.3 Clinical Picture 314
III.4.4 Incidence and Prevalence 316
III.4.5 Etiology 317
III.4.6 Prognosis 318
III.4.7 Accuracy of Diagnostic Criteria 318
III.5 Frontotemporal Lobar Atrophies:The Pick Complex 321
III.5.1 Introduction 321
III.5.2 Clinical Features 322
III.5.3 Basic Biology of Tau 324
III.5.4 Structural Substrates 324
III.5.5 Alterations in Tau Proteins and Gene 327
III.5.6 Pathogenic Mechanisms in Pick Complex 328
III.5.7 Incidence and Prevalence 329
III.5.8 Diagnostic Tests 329
III.5.9 Diagnostic Criteria and Differential Diagnosis 330
III.5.10 Clinical Vignette 331
III.6 Other Important Dementias 336
III.6.1 Introduction 336
III.6.2 Parkinson’s Disease 336
III.6.3 Huntington’s Disease 340
III.6.4 Progressive Supranuclear Palsy 342
III.6.5 Multiple System Atrophy 343
III.6.6 Corticobasal Degeneration 343
III.6.7 Conclusions 344
III.6.8 Infectious Dementias 344
III.7 Reversible or Arrestable Dementias 354
III.7.1 Introduction 354
III.7.2 Normal Pressure Hydrocephalus and Intracranial Space-occupying Lesions 356
III.7.3 Depression 357
III.7.4 Drugs 358
III.7.5 Thyroid 359
III.7.6 Vitamin B12 360
III.7.7 Folate 360
III.7.8 Other Potentially Reversible Conditions 361
III.7.9 Summary 362
III.8 Mild Cognitive Impairment 365
III.8.1 Introduction 365
III.8.2 Definition and Diagnostic Criteria 366
III.8.3 Clinical Picture 367
III.8.4 Diagnostic Tools 368
III.8.5 Incidence, Prevalence and Burden 369
III.8.6 Epidemiologic Risk Factors 370
III.8.7 Prognosis 370
III.8.8 Pathology/Pathogenetic Etiology 372
III.8.9 Likely Subtypes of MCI 374
III.8.10 Treatment of MCI 375
Section IV Overview of Treatment and Management 379
IV.1 Aims of Treatment 381
IV.2 Criteria for Clinical Decisions 383
IV.2.1 What is the Diagnosis? 383
IV.2.2 What are the Patient’s Principal Problems? 384
IV.2.3 What is the Prognosis? 384
IV.2.4 What are the Patient and Family Expectations? 386
IV.2.5 What is the Likelihood of Treatment Benefit? 387
IV.3 Clinical Decisions in Practice 389
IV.3.1 Rationale for Treatment–Assessing the Evidence 389
IV.3.2 From Groups to Individuals 390
IV.3.3 The Application of Specific Treatments for Dementia 391
IV.3.4 Caregivers in the Therapeutics of Dementia 392
IV.3.5 Treatment of Mood Changes and Depression 392
IV.3.6 Treatment of Behavioral Changes 393
IV.3.7 Cognitive Therapies 394
IV.3.8 Preventative Therapies 394
IV.3.9 Principles of Administration 395
IV.3.10 Monitoring Treatment Effects 395
IV.4 Delivering an Integrated Treatment Plan 397
IV.4.1 Establishing a Knowledge Base and Providing Education 397
IV.4.2 Addressing Social and Environmental Needs 397
IV.4.3 Health Maintenance 398
IV.4.4 Behavioral Management 398
IV.4.5 Neurological Management 398
IV.4.6 Cognitive Function 399
IV.4.7 Prevention 399
IV.5 What is the Evidence that a Dementia Treatment Works? 400
IV.5.1 Criteria Used by Drug Regulatory Authorities 400
IV.5.2 Criteria Used by Purchasers of Health Care Services 411
IV.5.3 Dementia Trials for Cognitive Symptoms and Modification of Prognosis: Past, Present and Future 429
IV.5.4 Individualizing Symptomatic Therapy: n-of-1 Trials 441
IV.6 Non-pharmacological Techniques 452
IV.6.1 Introduction 452
IV.6.2 Reality Orientation 454
IV.6.3 Reminiscence Therapy 457
IV.6.4 Validation Therapy 458
IV.6.5 Memory Training 459
IV.6.6 Stimulation 460
IV.6.7 Cognitive–behavioral Therapy 461
IV.6.8 Behavioral Approaches 462
IV.6.9 Conclusion and Integration 465
IV.6.10 Summary of Key Points 466
IV.7 Drugs in Development and Experimental Approaches 471
Section V Therapies for Cognitive Symptoms, Disease Modification and Prevention 483
V.1 Introduction to Specific Therapies for Cognitive Symptoms or Modifying Disease Prognosis 485
V.2 Treatment of Alzheimer’s Disease (With or Without Cerebrovascular Disease) 491
V.2.1 Introduction 491
V.2.2 Acetyl-L-carnitine 492
V.2.3 Antioxidant Vitamins 495
V.2.4 Donepezil in the Treatment of Alzheimer’s Disease 497
V.2.5 Galantamine 508
V.2.6 Metrifonate 517
V.2.7 Rivastigmine 523
V.2.8 Tacrine 533
V.2.9 D-Cycloserine 540
V.2.10 Ginkgo Biloba 542
V.2.11 Estrogen 547
V.2.12 Hydergine 550
V.2.13 Idebenone 554
V.2.14 Nicotine 559
V.2.15 Nimodipine 561
V.2.16 Non-steroidal Anti-inflammatory Drugs 565
V.2.17 Piracetam 570
V.2.18 Propentofylline 572
V.2.19 Selegiline in the Treatment of Alzheimer’s Disease 577
V.2.20 Thiamine 581
V.2.21 Summary, Practical Recommendations and Opinions on Therapies for Cognitive Symptoms and Prognosis Modification 584
V.3 Treatment of Vascular Dementia 613
V.3.1 Introduction 613
V.3.2 Antioxidants 613
V.3.3 Antithrombotics 614
V.3.4 Blood Pressure Reduction 617
V.3.5 CDP-choline 620
V.3.6 Ginkgo Biloba 623
V.3.7 Hydergine 623
V.3.8 Nimodipine 624
V.3.9 Pentoxifylline 624
V.3.10 Piracetam 627
V.3.11 Propentofylline 627
V.3.12 Summary, Practical Recommendations and Conclusions 627
V.4 Treatment of Lewy Body Dementia 632
V.5 Treatment of Reversible or Arrestable Dementias 639
V.5.1 Introduction 639
V.5.2 Infections of the Central Nervous System 640
V.5.3 Traumatic Brain Injury and Dementia Pugilistica 644
V.5.4 Alcohol-related Dementia 644
V.5.5 Cerebral Hypoxia/Anoxia 645
V.5.6 Tumors and Malignancy 651
V.5.7 Vitamin Deficiencies 652
V.5.8 Metabolic Causes 652
V.5.9 Chronic Disease 654
V.5.10 Conclusion 655
V.6 Treatment of Age-associated Memory Impairment 663
V.7 Prevention of Dementia 678
Section VI Treating Non-cognitive Problems 691
VI.A A Problem-oriented Approach to Common Psychiatric Problems 693
VI.1 Introduction 695
VI.2 Classes of Psychotropics–Overview of Evidence from Clinical Trials 699
VI.2.1 Conventional Antipsychotics 699
VI.2.2 Atypical Antipsychotics 701
VI.2.3 Anxiolytics 702
VI.2.4 Anticonvulsants 706
VI.2.5 Other Classes of Psychotropics in Dementia 710
VI.3 Problems 719
VI.3.1 Depressive Features in Dementia 719
VI.3.2 Psychosis 722
VI.3.3 Agitation 729
VI.3.4 Hypersexuality 731
VI.3.5 Sleep Disturbance 735
VI.4 Summary, Practical Recommendations and Opinions 744
VI.B A Problem-oriented Approach to Common Medical Problems 747
VI.5 Common Medical Problems 749
VI.5.1 Introduction 749
VI.5.2 Delirium 752
VI.5.3 Seizures 754
VI.5.4 Mobility, Falls and Fractures 755
VI.5.5 Feeding Problems and Weight Loss 757
VI.5.6 Incontinence 758
VI.5.7 Death 763
Section VII Social, Ethical and Health Services Issues 769
VII.1 Social and Ethical Issues 771
VII.1.1 Respect and Care for the Person with Dementia 771
VII.1.2 Diagnostic Truth-telling and Precedent Autonomy 772
VII.1.3 Research Ethics and Informed Consent 772
VII.1.4 Quality of Life, Morbidity Protraction, and Cognitive Enhancing Drugs 774
VII.1.5 Dying Well in Advanced Dementia:The Ethics of Nutrition and Hydration 775
VII.2 Driving 779
VII.3 Care-giver Interventions 788
VII.4 Genetic Counseling 819
VII.5 Nursing Home Care for Patients with Dementia 825
VII.6 Organization of Care 835
VII.6.1 Introduction 835
VII.6.2 Determining Population Needs, and Service Planning 836
VII.6.3 Individual Components of a Dementia Service 837
VII.6.4 Monitoring and Evaluating Services 848
VII.6.5 Conclusions and Future Research Priorities 849
VII.7 Memory Clinics–a Guide to Implementation and Evaluation 852
VII.7.1 Background 852
VII.7.2 Summary of Rationale for Establishing a Memory Clinic 853
VII.7.3 Setting up a Memory Clinic 853
VII.7.4 The Future Development of the Memory Clinic 861
VII.8 Health Economics 868
VII.8.1 Introduction 868
VII.8.2 Methods 869
VII.8.3 Cost Analyses and Cost-of-Illness Studies 869
VII.8.4 Diagnosis 872
VII.8.5 Evaluations of Care and Treatment 873
VII.8.6 Economic Evaluation of Drug Interventions 874
VII.8.7 Conclusions 876
Appendices 879
Appendix I. Diagnostic Criteria for Common Dementias 879
Appendix II. Dementia Rating Scales 883
Appendix III National Alzheimer’s Disease and Dementia Associations and Societies 894
Abbreviations 899
Index 903