Fluvoxamine in the treatment of demented elderly patients: a double‐blind, placebo‐controlled study

122

119

To develop evidence based consensus statements on which to build clinical practice guidelines for primary care physicians towards the recognition, assessment and management of dementing disorders; ii) to disseminate and evaluate the impact of these statements and guidelines built on these statements. O p t i o n s : Structured approach to assessment, including recommended laboratory tests, choices for neuroimaging and referral; management of complications (especially behaviour problems and depression) and use of cognitive enhancing agents. Potential outcomes: Consistent and improved clinical care of persons with dementia; cost containment by more selective use of laboratory investigations, neuroimaging and referrals; appropriate use of cognitive enhancing agents. E v i d e n c e : Authors of each background paper were entrusted to: perform a literature search, discover additional relevant material including references cited in retrieved articles; consult with other experts in the field and then synthesize information. Standard rules of evidence were applied. Based upon this evidence, consensus statements were developed by a group of experts, guided by a steering committee of eight individuals from the areas of Neurology, Geriatric Medicine, Psychiatry, Family Développer des énoncés consensuels basés sur les données actuelles de la science sur lesquels on puisse construire des lignes directrices cliniques pour les médecins de première ligne pour l'identification, l'évaluation et la prise en charge des patients déments; ii) diffuser et évaluer l'impact de ces énoncés et des lignes directrices basées sur ces énoncés. O p t i o n s : Une approche structurée pour l'évaluation, incluant les épreuves de laboratoire recommandées, les choix d'examens de neuroimagerie et de référence en spécialité; la prise en charge des complications (spécialement des problèmes de comportement et de dépression) et l'utilisation d'agents qui améliorent la fonction cognitive. Bénéfices potentiels: Des soins améliorés et fiables aux personnes démentes; un contrôle des coûts par une utilisation plus judicieuse des examens de laboratoire, de la neuroimagerie et de la référence en spécialité; une utilisation appropriée des agents qui améliorent la fonction cognitive. É v i d e n c e : Les auteurs de chaque article de fond ont reçu le mandat de faire une recherche de la littérature pour ajouter des informations pertinentes incluant les références citées dans ces articles; consulter d'autres experts dans ce domaine et faire une synthèse de l'information. Ces tâches ont été effectuées conformément aux normes de la preuve. Sur la foi de cette évidence, les énoncés consensuels ont été développés par un groupe d'experts, guidé par un comité de direction de huit individus des domaines de la neurologie, de la gériatrie, de la psychiatrie, de la médecine familiale, de la médecine préventive et des systèmes de santé. Va l e u r s : Des recommandations ont été développées en portant une attention particulière sur le contexte des soins de première ligne ...

Section: Depression and Dementiamentioning

confidence: 99%

The Recognition, Assessment and Management of Dementing Disorders: Conclusions from the Canadian Consensus Conference on Dementia

Patterson

Grek

Gauthier

et al. 2001

122

119

“…[10][11][12][13][14] Thus, it is possible to identify a high risk group who would benefit if safe prophylactic interventions to prevent dementia become available. Studies comparing possible treatments (vitamin E, donepezil, rivastigmine, cox II inhibitors) to placebo are currently underway with up to three years follow-up.…”

Section: Primary Prevention Of Dementiamentioning

confidence: 99%

Preventing Dementia

Black

Patterson

Feightner

2001

Suppl. 1 -S56The concept of primary prevention of dementia is relatively new but will assume increasing importance as dementia prevalence increases in our graying population 1 and as the etiological factors and molecular pathogenetic mechanisms of primary degenerative dementias become better understood. 2Current definitions of dementia require memory impairment and cognitive dysfunction in at least one other domain of sufficient degree to interfere with social functioning.3 In this review we emphasize prevention of dementia in individuals who are cognitively normal but may be at risk for dementia, or who are cognitively impaired but not yet demented. Potential preventative measures include avoidance or control of modifiable risk factors to prevent progression to clinically manifest dementia. Secondary prevention of the degenerative dementias is equivalent to treatment, which is discussed in a companion article in this series. Recent clinical trials have provided evidence for modest symptomatic stabilization with socalled cognitive enhancing agents. If effective retardive therapies or neuroregenerative strategies are developed, in the future it may be possible to delay progression or even partially reverse dementing illness.ABSTRACT: Primary prevention will become increasingly important as dementia prevalence increases and effective retardive therapies are developed. To date, only one randomized controlled trial (involving treatment of systolic hypertension) has demonstrated that the incidence of dementia can be reduced. Physicians should remain alert to possible secondary causes of dementia and correct these whenever possible. Primary and secondary prevention of stroke should reduce dementia related to cerebrovascular disease either directly or as a comorbid factor in Alzheimer's disease (AD). Epidemiological studies have revealed a number of risk factors for AD including genetic mutation, susceptibility genes, positive family history, Down's syndrome, age, sex, years of education, head trauma and neurotoxins. In casecontrol studies non-steroidal anti-inflammatory medication and estrogen replacement therapy appear to decrease the relative risk of developing AD. Further research to develop and test preventative therapies in AD and other dementias should be strongly encouraged.RÉSUMÉ: Prévention de la démence. La prévention primaire va devenir de plus en plus importante à mesure que la prévalence de la démence augmente et que des stratégies efficaces pour en retarder l'apparition sont développées. Pour l'instant, une seule étude randomisée contrôlée (traitement de l'hypertension systolique) a démontré que l'incidence de la démence peut être réduite. Les médecins devraient demeurer vigilants pour détecter la présence causes secondaires de démence et les corriger si possible. La prévention primaire et secondaire de l'accident vasculaire cérébral devrait diminuer l'incidence de la démence reliée à la maladie cérébrovasculaire, soit directement ou comme facteur de comorbidité dans la maladie d'Alzheimer (MA). Des étud...

“…117 In a double-blind, placebo-controlled trial of fluvoxamine in 46 patients with dementia, there were no statistically significant differences, though trends were noted favouring the fluvoxamine for improvement on a variety of behavioral symptoms. 118 In a large, well-designed, double-blind, placebo-controlled trial of citalopram in 98 dementia patients, significant improvement was noted in symptoms such as confusion, irritability, anxiety, fear and restlessness in the citalopram group. 119 Because the patients in this study were only mildly disturbed, Pollack et al 120 have recently attempted to replicate these results in an open study of 16 patients with moderate to severe psychosis or other behaviour problems.…”

Section: -111mentioning

confidence: 99%

Recommendations for the Management of Behavioral and Psychological Symptoms of Dementia

Herrmann

2001

Suppl. 1 -S96 serious problem that they encountered, rating it more frequently as a serious problem than the memory disturbance itself. The significance of BPSD was recently endorsed by both the United States A l z h e i m e r's A s s o c i a t i o n 6 and the International Psychogeriatric Association 1 as research priorities. The phenomenology and prevalence of BPSD have beenThe behavioral and psychological symptoms of dementia (BPSD) include delusions, hallucinations, misidentifications, agitation, wandering, pacing, restlessness, disinhibition, apathy, negativism, emotional lability, depression, anxiety, sleep disturbance and sexually inappropriate behaviours.1 While not included as diagnostic criteria for dementia by DSM-IV 2 or the NINCDS-ADRDA, 3 behaviours such as paranoia, depression, euphoria and apathy were recognized by Alzheimer in the initial description of the illness that bears his name. 4 Historically, the focus on BPSD began only recently, prompted by an early study by Rabins et al,5 who interviewed caregivers of patients with dementia. While these behaviours were noted in 50-90% of patients, caregivers considered physical aggression the most ABSTRACT: Background: The behavioral and psychological symptoms of dementia (BPSD) are common, serious problems that impair the quality of life for both patient and caregiver. In order to provide recommendations based upon the best available evidence, a qualitative literature review was performed. Methods: A search of the English language medical literature published between 1966 and 2000 was performed. The quality of the studies was assessed by considering the subjects, trial design, analysis and results. Final recommendations were based upon the quality of available evidence. Results: The management of BPSD begins with a thorough assessment to search for underlying causes of behaviour change. Concomitant medical illness should be treated and sensory impairment ameliorated. Nonpharmacological approaches should be instituted prior to medication use. These interventions include music, light, changes in level of stimulation and specific behavioral techniques. Antipsychotics are the best studied pharmacological intervention for agitation and aggression and have demonstrated modest but consistent efficacy. Antidepressants such as trazodone and selective serotonin re-uptake inhibitors, as well as anticonvulsants such as carbamazepine and valproic acid have also demonstrated efficacy. Benzodiazepines can be used for short-term treatment as p.r.n. agents when necessary. Pharmacotherapy must be monitored closely for both effectiveness and side effects, with consideration of medication withdrawal when appropriate. Conclusion: The management of BPSD can significantly improve the quality of life for the patient and caregiver. Their assessment and management are essential components of the treatment of dementia.RÉSUMÉ: Recommandations pour la prise en charge des symptômes comportementaux et psychologiques de la démence. Introduction: L e s symptômes comportementaux et ...