Mild Alzheimer's disease: A «Position Paper»

Delrieu, Julien; Voisin, Thierry; Andrieu, Sandrine; Belliard, Serge; Belmin, Joël; Blanchard, F.; Ceccaldi, Mathieu; Dartigues, Jean‐François; Defontaines, Bénédicte; Lehericy, Stéphane; Mékiès, Claude; Moreaud, Olivier; Naccache, Lionel; Nourhashémi, Fati; Ousset, P.-J.; Pasquier, Florence; Payoux, Pierre; Puisieux, François; Robert, Philippe; Touchon, Jacques; Vellas, Bruno; Dubois, Bruno

doi:10.1007/s12603-009-0101-2

Cited by 9 publications

(5 citation statements)

References 82 publications

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“…Clinical research (12), most published clinical trial data (13) and expert opinion (3,14) are clearly supportive of this perspective. Thus, the most important consequence of underdiagnosis was perceived as missing the window of opportunity to provide the patient with the most effective treatment.…”

Section: Discussionmentioning

confidence: 86%

Assessing physician attitudes and perceptions of Alzheimer's disease across Europe

Martínez-Lage

Frölich

Knox

et al. 2010

The Journal of nutrition, health and aging

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Given the important role that physicians play in clinical care, disease advocacy, national health policy making and clinical research, the IMPACT survey sought to assess the attitudes and perceptions of physicians in 3 general categories: diagnosis and treatment of Alzheimer's disease (AD); caregivers and families of patients with AD; and the role of government in dealing with this disease and its consequences. Survey respondents comprised a total of 250 generalists and 250 specialists (neurologists, geriatricians, neuro-psychiatrists, psychiatrists and psychogeriatricians) from France, Germany, Italy, Spain and the United Kingdom. Physicians were aged 25 to 69 years, in practice for between 5 and 30 years and currently spending more than 50% of their time in direct patient care. Results showed that a sizable majority of physicians throughout Europe, specialists and generalists alike, agree that: 1) AD is underdiagnosed and undertreated; 2) patients and families are not prepared to recognise the early symptoms of the disease; 3) early treatment can help to slow the progression of the disease; and 4) more effective treatments are needed. Attitudes were statistically significantly different between some groups of physicians regarding disclosure of the diagnosis of AD, the benefits of lifestyle modification, and the value of AD-specific medication in patients whose symptoms are worsening. Differences in attitudes and perceptions of AD between specialists and generalists were limited; differences between countries were more common and of greater magnitude, particularly with respect to barriers to the use of prescription medications.

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Section: Discussionmentioning

confidence: 86%

Assessing physician attitudes and perceptions of Alzheimer's disease across Europe

Martínez-Lage

Frölich

Knox

et al. 2010

The Journal of nutrition, health and aging

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“…The guidelines seem to differ in their position about the need for a specialist consultation for “typical” cases of dementia, with some of the international position papers favouring a confirmation of the diagnosis by a specialist. (11–13,17,18) This differs from the position of the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCD) held in March 2006, which proposed that the typical presentations of the most common types of dementia can be accurately diagnosed by PCP, even in the early stages of the disease. (8) While acknowledging the challenges in primary care, CCCD maintains that the diagnosis can be made by PCP through clinical evaluation, brief cognitive testing, basic laboratory tests, and structural imaging, as appropriate.…”

Section: Resultsmentioning

confidence: 99%

“…(7,17,24,29,30,33,34,40) Delays in the diagnostic evaluation may occur even when a suspicion of dementia is raised by family and/or by positive cognitive screening results. (41,42) The results of a few recent large scale and multinational Canadian, European, and Australian surveys confirm major difficulties experienced by both the physicians and the public in recognizing and responding to early dementia symptoms, and significant delays in both seeking help and the provision of a dementia diagnosis.…”

Section: Resultsmentioning

confidence: 99%

“…(17,25,27,34,57,58) For instance, many PCP express low confidence in making a diagnosis of dementia particularly in the early stages of the disease, (54,55,57–62) feel that their training has been insufficient to prepare them for this task, (25,63–65) and express a strong desire for a specialist consultation. (25,56,58,62,66,67) There is evidence that many PCP view the diagnosis and management of dementia disorders as being more complex than other chronic conditions, both biologically and psychosocially.…”

Section: Resultsmentioning

confidence: 99%

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A Review of Barriers and Enablers to Diagnosis and Management of Persons with Dementia in Primary Care

et al. 2012

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BackgroundWith the rise in the prevalence of dementia disorders and the growing critical impact of dementia on health-care resources, the provision of dementia care has increasingly come under scrutiny, with primary care physicians (PCP) being at the centre of such attention.PurposeTo critically examine barriers and enablers to timely diagnosis and optimal management of community living persons with dementia (PWD) in primary care.MethodsAn interpretive scoping review was used to synthesize and analyze an extensive body of heterogeneous Western literature published over the past decade.ResultsThe current primary care systems in many Western countries, including Canada, face many challenges in providing responsive, comprehensive, safe, and cost-effective dementia care. This paper has identified a multitude of highly inter-related obstacles to optimal primary dementia care, including challenges related to: a) the complex biomedical, psychosocial, and ethical nature of the condition; b) the gaps in knowledge, skills, attitudes, and resources of PWD/caregivers and their primary care providers; and c) the broader systemic and structural barriers negatively affecting the context of dementia care.ConclusionsFurther progress will require a coordinated campaign and significantly increased levels of commitment and effort, which should be ideally orchestrated by national dementia strategies focusing on the barriers and enablers identified in this paper.

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“…The mild stage of Alzheimer's disease, during which the symptoms may be underestimated, represents a 'bridging' period of the disease (the patient enters into the dementia stage of the disease when the cognitive impairment impacts on everyday activities). [3] The progressive degeneration of neurons produces abnormalities of the neurotransmitter systems. A combination of cholinergic and glutamatergic dysfunction appears to underlie the symptomatology of Alzheimer's disease and, thus, treatment strategies should address impairments in both systems.…”

Section: Natural Course Of Alzheimer's Diseasementioning

confidence: 99%

Managing Cognitive Dysfunction through the Continuum of Alzheimerʼs Disease

et al. 2011

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It has been shown that, during several years preceding the diagnosis of Alzheimer's disease there is a gradual cognitive decline with a continuum between the pre-dementia stage (still known as the prodromal stage but now included within the general concept of mild cognitive impairment [MCI]) and the other stages of the disease. In MCI, the use of cholinesterase inhibitors (ChEIs) is not associated with any delay in the onset of Alzheimer's disease or dementia. During the dementia stages, the three ChEIs (donepezil, galantamine and rivastigmine) are efficacious for mild to moderate Alzheimer's disease; therefore, monotherapy with a ChEI can be envisaged as initial treatment. Confirmation of the efficacy of ChEIs in the mild dementia stage is essentially based on the results from a single, randomized study carried out specifically among patients at this stage of severity. Memantine can represent an alternative to ChEIs in the moderate stage of Alzheimer's disease. At the severe stage of the disease, memantine and donepezil are currently indicated. Indeed, memantine has been approved by numerous drug regulatory agencies for use in severe stages of the disease, whereas donepezil has only been approved by the US FDA. There is currently insufficient evidence for recommending combination therapy in Alzheimer's disease.

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Mild Alzheimer's disease: A «Position Paper»

Cited by 9 publications

References 82 publications

Assessing physician attitudes and perceptions of Alzheimer's disease across Europe

Assessing physician attitudes and perceptions of Alzheimer's disease across Europe

A Review of Barriers and Enablers to Diagnosis and Management of Persons with Dementia in Primary Care

Managing Cognitive Dysfunction through the Continuum of Alzheimerʼs Disease

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