Recommendations of the 5th Canadian Consensus Conference on the diagnosis and treatment of dementia

Abstract

Since 1989, four Canadian Consensus Conferences on the Diagnosis and Treatment of Dementia (CCCDTD) have provided evidence‐based dementia guidelines for Canadian clinicians and researchers. We present the results of the 5th CCCDTD, which convened in October 2019, to address topics chosen by the steering committee to reflect advances in the field, and build on previous guidelines. Topics included: (1) utility of the National Institute on Aging research framework for clinical Alzheimer's disease (AD) diagnosis; (2) updating diagnostic criteria for vascular cognitive impairment, and its management; (3) dementia case finding and detection; (4) neuroimaging and fluid biomarkers in diagnosis; (5) use of non‐cognitive markers of dementia for better dementia detection; (6) risk reduction/prevention; (7) psychosocial and non‐pharmacological interventions; and (8) deprescription of medications used to treat dementia. We hope the guidelines are useful for clinicians, researchers, policy makers, and the lay public, to inform a current and evidence‐based approach to dementia.

Cumulative health deficits, APOE genotype, and risk for later-life mild cognitive impairment and dementia

“…[11][12][13] Measuring each individual's degree of frailty may help identify those individuals without cognitive impairment most likely to develop MCI, 14 and those with MCI most likely to progress to dementia. 15 Critically, despite recent recommendations in support of preventing and mitigating frailty 16 -chiefly through lifestyle interventions that overlap with those proposed for dementia-it is not yet known whether frailty plays an equal role in dementia development in relation to a genetic predisposition to dementia. Recent evidence is mixed about whether a healthy lifestyle reduces dementia risk in those at high genetic risk.…”

<p>Dementia Diagnoses and Treatment in Geriatric Ward Patients: A Cross-Sectional Study in Poland</p>

“…They may also be considered for the treatment of vascular cognitive impairment and in selected parkinsonian patients. 13,46 But in Poland, donepezil treatment is reimbursed only in AD, Lewy Body dementia, and PDD, whereas rivastigmine is reimbursed only in AD. Finally, it should also be taken into account that drugs used in dementia have no causal effect but act only symptomatically.…”

“…Their effectiveness is limited, may change over time, or side effects may prevent their use in some patients. 13 This can also affect their prescribing, and high rates of non-persistence in dementia patients who received a prescription for cognitive enhancers. Research carried out in Germany, for example, showed that only 69.9% of patients aged >70 who received a prescription for anti-dementia medication were on it six months after initiation of treatment, and only 56.2% after 12 months.…”

“…[4][5][6][7] In many countries, there is still the problem of late detection of dementia and too little appropriate therapy implementation. [8][9][10][11][12] Although no systematic screening for dementia in the general population is recommended, 13 it is emphasized, that assessing cognitive performance ought to be the inherent part of a comprehensive geriatric assessment. 14 Some studies support the diagnosis of dementia in very elderly patients with multiple comorbidities, as influencing their prognosis and quality of life.…”

Remote cognitive and behavioral assessment: Report of the Alzheimer Society of Canada Task Force on dementia care best practices for COVID‐19

“…History from an informant is essential to a thorough and reliable cognitive assessment, given the role of anosognosia. Consistent with the recent Fifth Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD5) recommendations, cognitive assessments include information on cognition, function, and behavior, and fundamentally both patient or care partner are required as sources of information 16 . With the patient's consent, history can be obtained by phone from an informant located in a separate, private space or during a separate appointment.…”