Approach to the forgetful patient

Yoon, Peng Soon; Ooi, Chun How; How, Choon How

doi:10.11622/smedj.2018026

Cited by 4 publications

(3 citation statements)

References 3 publications

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“…Another study from Singapore recommends that PCPs refer PwD to memory clinics after diagnosis to provide a multidisciplinary approach to care. At the memory clinic, a multidisciplinary team comprised of clinicians, dementia-trained nurses, physiotherapists, social workers, occupational therapists, and psychologists can consult on comorbidities in addition to managing dementia [ 65 ].…”

Section: Resultsmentioning

confidence: 99%

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Dementia and comorbidities in primary care: a scoping review

Bergman,

Borson,

Jessen

et al. 2023

BMC Prim. Care

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Background People with dementia (PwD) are known to have more chronic conditions compared to those without dementia, which can impact the clinical presentation of dementia, complicate clinical management and reduce overall quality of life. While primary care providers (PCPs) are integral to dementia care, it is currently unclear how PCPs adapt dementia care practices to account for comorbidities. This scoping review maps recent literature that describes the role for PCPs in the prevention, detection/diagnosis and management of dementia in the context of comorbidities, identifies critical knowledge gaps and proposes potential avenues for future research. Methods We searched for peer-reviewed literature published between 2017–2022 in MEDLINE, Cochrane Library, and Scopus using key terms related to dementia, primary care, and comorbidity. The literature was screened for relevance by title-abstract screening and subsequent full-text screening. The prioritized papers were categorized as either ‘Risk Assessment and Prevention’, ‘Screening, Detection, and Diagnosis’ or ‘Management’ and were further labelled as either ‘Tools and Technologies’, ‘Recommendations for Clinical Practice’ or ‘Programs and Initiatives’. Results We identified 1,058 unique records in our search and respectively excluded 800 and 230 publications during title-abstract and full-text screening. Twenty-eight articles were included in our review, where ~ 50% describe the development and testing of tools and technologies that use pre-existing conditions to assess dementia risk. Only one publication provides official dementia screening guidelines for PCPs in people with pre-existing conditions. About 30% of the articles discuss managing the care of PwD, where most were anchored around models of multidisciplinary care and mitigating potentially inappropriate prescribing. Conclusion To our knowledge, this is the first scoping review that examines the role for PCPs in the prevention, detection/diagnosis and management of dementia in the context of comorbidities. Given our findings, we recommend that future studies: 1) further validate tools for risk assessment, timely detection and diagnosis that incorporate other health conditions; 2) provide additional guidance into how comorbidities could impact dementia care (including prescribing medication) in primary care settings; 3) incorporate comorbidities into primary care quality indicators for dementia; and 4) explore how to best incorporate dementia and comorbidities into models/frameworks of holistic, person-centred care.

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Section: Resultsmentioning

confidence: 99%

“…It has been noted that PCPs are well-positioned to provide such care [ 1 , 11 , 23 ]. In our review, two studies recommended that PCPs account for comorbidities when delivering person-centred dementia care [ 63 , 65 ]. In addition, we also identified two programs/initiatives (e.g.…”

Section: Discussionmentioning

confidence: 99%

Dementia and comorbidities in primary care: a scoping review

Bergman,

Borson,

Jessen

et al. 2023

BMC Prim. Care

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“…The non-cognitive symptoms, behavioral and psychological symptoms of dementia (BPSD) are usually related to AD, with perception, thought content, mood, and behavior disorders included. According to a study, 70–90% of patients with dementia in the progression of the disease will appear to have BPSD within a certain period of time (2), which contributes the most to hospitalization and life quality deterioration for patients with AD, and seriously increases family and caregiver burden (3,4). Results from South Korea have pointed out that caregivers' psychological distress mainly comes from BPSD when they are taking care of patients with dementia, and for the registered nurses and care workers, the most frequent distressing symptom is agitation/aggression.…”

Section: Introductionmentioning

confidence: 99%

Effect of memantine combined with citalopram on cognition of BPSD and moderate Alzheimer's disease: A clinical trial

et al. 2018

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Among Alzheimer's disease (AD) patients, it is very common to develop behavioral and psychological symptoms of dementia (BPSD), which has a close relation to the excess morbidity and mortality, greater healthcare use, earlier institutionalization, and caregiver burden. With evaluation of AD patients, the present study mainly aims to investigate whether citalopram would be efficient for BPSD, and examines citalopram's effects on cognitive function, caregiver distress, safety and tolerability. Eighty patients diagnosed with moderate AD and clinically significant BPSD from April 2015 to January 2016 were enrolled in this study. Patients randomly received memantine plus either citalopram (n=40, study group) or placebo (n=40, control group) in a 12-week period. The target dose of memantine was 20 mg/day. The dose of citalopram was 10 mg/day in the beginning with planned titration to 30 mg/day over 2 weeks on the basis of response and tolerability. Blood routine, urine routine, biochemical tests, electrocardiogram and electroencephalogram were carried out for each patient every month routinely to check the change induced by using medication. Treatment Emergent Symptom Scale (TESS) was used to measure untoward effects every 2 weeks. All of the agitation/aggression, irritability/lability, night-time behavioral disturbances, caregiver distress and Neuropsychiatric Inventory (NPI) total scores after treatment were found to be dramatically lower than those before treatment in both groups. Apathy, dysphoria and anxiety received lower scores in participants who received memantine combined with citalopram, compared to those before treatment. QTc interval prolongation was observed in 2 patients who were treated with 30 mg/day citalopramin. In conclusion, memantine combined with citalopram can more effectively improve the cognitive function, and reduce behavioral and psychological symptoms in patients with moderate AD. Cardiac adverse effects of citalopram are not common when the dose is <30 mg/day, which does not limit its practical application. Thus, citalopram has shown potential efficacy in adjunctive therapy of AD patients with BPSD.

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Dementia management: a brief overview for primary care clinicians

Poon

Ooi

How

et al. 2018

smedj

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With the increasing life expectancy and ageing population in Singapore, we are likely to see more patients with dementia seeking help from their primary care clinicians. Acetylcholinesterase inhibitors and N-Methyl-D-aspartate receptor antagonists for dementia management can be costly given their modest efficacy, and it is important to discuss the risks and benefits with patients before a shared decision is made. Non-pharmacological management such as regular structured routine, good sleep hygiene, reminiscence and other activities are also useful in improving the well-being of dementia patients. Caregivers and family members can be advised on what to watch out for to keep patients safe at home and outdoors, as dementia patients have poor safety awareness. The primary care clinician can manage depression, if present, and refer the patient to memory clinics or appropriate specialist clinics for further assessment when indicated.

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Approach to the forgetful patient

Cited by 4 publications

References 3 publications

Dementia and comorbidities in primary care: a scoping review

Dementia and comorbidities in primary care: a scoping review

Effect of memantine combined with citalopram on cognition of BPSD and moderate Alzheimer's disease: A clinical trial

Dementia management: a brief overview for primary care clinicians

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