Practice parameter: Management of dementia (an evidence-based review) [RETIRED]

TLDR

The study aims to define key issues in dementia management and provide literature‑based treatment recommendations. The authors conducted a literature search addressing four clinical questions on pharmacotherapy, non‑pharmacologic interventions, and educational strategies for dementia. The review found that cholinesterase inhibitors and vitamin E offer modest benefits for Alzheimer’s disease, antipsychotics and antidepressants are effective for agitation, psychosis, and depression, while educational and behavioral interventions improve caregiver satisfaction, delay nursing‑home placement, reduce antipsychotic use, lower urinary incontinence, and enhance functional independence.

Abstract

<b><i>Objective: </i></b> To define and investigate key issues in the management of dementia and to make literature-based treatment recommendations. <b><i>Methods:</i></b> The authors searched the literature for four clinical questions: 1) Does pharmacotherapy for cognitive symptoms improve outcomes in patients with dementia? 2) Does pharmacotherapy for noncognitive symptoms improve outcomes in patients with dementia? 3) Do educational interventions improve outcomes in patients and/or caregivers? 4) Do other nonpharmacologic interventions improve outcomes in patients and/or caregivers? <b><i>Results:</i></b> Cholinesterase inhibitors benefit patients with AD (Standard), although the average benefit appears small; vitamin E likely delays the time to clinical worsening (Guideline); selegiline, other antioxidants, anti-inflammatories, and estrogen require further study. Antipsychotics are effective for agitation or psychosis in patients with dementia where environmental manipulation fails (Standard), and antidepressants are effective in depressed patients with dementia (Guideline). Educational programs should be offered to family caregivers to improve caregiver satisfaction and to delay the time to nursing home placement (Guideline). Staff of long-term care facilities should also be educated about AD to minimize the unnecessary use of antipsychotic medications (Guideline). Behavior modification, scheduled toileting, and prompted voiding reduce urinary incontinence (Standard). Functional independence can be increased by graded assistance, skills practice, and positive reinforcement (Guideline).