Current Pharmacologic Treatment of Dementia: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians

Abstract

The targeted literature search included evidence related to the effectiveness of 5 U.S. Food and Drug Administration-approved pharmacologic therapies for dementia for outcomes in the domains of cognition, global function, behavior/mood, and quality of life/activities of daily living. RECOMMENDATION 1: Clinicians should base the decision to initiate a trial of therapy with a cholinesterase inhibitor or memantine on individualized assessment. (Grade: weak recommendation, moderate-quality evidence.) RECOMMENDATION 2: Clinicians should base the choice of pharmacologic agents on tolerability, adverse effect profile, ease of use, and cost of medication. The evidence is insufficient to compare the effectiveness of different pharmacologic agents for the treatment of dementia. (Grade: weak recommendation, low-quality evidence.) RECOMMENDATION 3: There is an urgent need for further research on the clinical effectiveness of pharmacologic management of dementia.

Improving the relevance and consistency of outcomes in comparative effectiveness research

“…For example, clinical guidelines issued by the American College of Physicians noted that the ability to provide strong recommendations was limited by the absence of measures of cognitive function that are commonly used in clinical care [5]. Medicare declined to provide reimbursement for cervical artificial discs in part because they viewed the outcomes reported in the trials as uninformative for key aspects of patient functional abilities [6].…”

A Drug Utilization Study of Cognition Enhancers in Dementia in a Tertiary Care Hospital in Mumbai

“…They further www.jcdr.net Karan Thakkar et al, Drug Utilization Study: Cognition Enhancers in Dementia say that one has to strike balance between harm and doubtful benefit of the CE drugs [15]. According to the National Institute of Health & Care Excellence (NICE) guidelines, donepezil, galantamine and rivastigmine are recommended as options for managing mild to moderate Alzheimer's disease, and memantine is recommended for managing moderate to severe Alzheimer's disease [16].…”

El sistema GRADE: un cambio en la forma de evaluar la calidad de la evidencia y la fuerza de recomendaciones

“…Estamos relativamente seguros de que el efecto real de la intervención se encuentra cerca de nuestra estimación Moderado El efecto real de la intervención probablemente se encuentra cerca de nuestra estimación, pero existe la posibilidad de que sea sustancialmente diferente Bajo El efecto real de la intervención puede ser sustancialmente diferente de nuestra estimación 9 . Si bien la memantina puede reducir el deterioro cognitivo de pacientes con demencia, el alto costo del medicamento, los potenciales efectos adversos y la pequeña magnitud del beneficio, condicionan que no sea apropiado utilizarlo en todos los pacientes con demencia.…”