Pharmacological recommendations for the symptomatic treatment of dementia: the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012
Identifieur interne : 000C96 ( Main/Exploration ); précédent : 000C95; suivant : 000C97Pharmacological recommendations for the symptomatic treatment of dementia: the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012
Auteurs : Nathan Herrmann [Canada] ; Krista L. Lanctôt [Canada] ; David B. Hogan [Canada]Source :
- Alzheimer's Research & Therapy [ 1758-9193 ] ; 2013.
Abstract
While there have been no new medications approved for the treatment of Alzheimer's disease (AD) or other dementias in Canada since 2004, the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD) reviewed and updated the clinical practice guidelines on the pharmacological management of dementia that were published previously.
This review focused on the literature for the pharmacological treatment of dementia based on studies published since the third CCCDTD in 2006. A literature search of English-language medical databases was preformed for studies pertaining to the pharmacological treatment of AD and other dementias that examined the management of cognitive and functional impairment, as well as neuropsychiatric symptoms. All previous recommendations were reviewed, and only those that required updating based on new published studies were revised. Several new recommendations were also added. Recommendations were rated for quality of evidence and were approved by consensus.
There were 15 revised or new recommendations approved by consensus. The revised recommendations included acknowledging that cholinesterase inhibitors (ChEIs) possess a class effect and any of the agents can be used for AD across the spectrum of severity and with co-existing cerebrovascular disease. There was insufficient evidence to recommend for or against the use of ChEIs in combination with memantine for the primary indication of treating neuropsychiatric symptoms, or for the treatment of vascular dementia. Recommendations for the discontinuation of cognitive enhancers were revised and clarified, as well as the risks associated with discontinuing these drugs. ChEIs were recommended as a treatment option for dementia with Parkinson's disease. Risks associated with use of antipsychotics for neuropsychiatric symptoms were strengthened, and guidelines regarding the use of antidepressants for affective disturbances in dementia were weakened, and are now considered an option but not a firm recommendation. Valproate was recommended not to be used, and there was insufficient evidence to recommend for or against the use of selective serotonin reuptake inhibitors or trazodone for the treatment of agitation and aggression.
In spite of the lack of new therapeutic agents for the treatment of dementia, recent studies have helped to clarify and strengthen recommendations to optimize the pharmacological management of these illnesses.
Url:
DOI: 10.1186/alzrt201
PubMed: 24565367
PubMed Central: 3980908
Affiliations:
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Lanctôt</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Psychiatry and the Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Suite FG08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Psychiatry and the Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Suite FG08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5</wicri:regionArea><wicri:noRegion>Ontario M4N 3M5</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:aff id="I2">Department of Psychiatry, University of Toronto, Suite FG08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Psychiatry, University of Toronto, Suite FG08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Hogan, David B" sort="Hogan, David B" uniqKey="Hogan D" first="David B" last="Hogan">David B. 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Lanctôt</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Psychiatry and the Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Suite FG08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Psychiatry and the Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Suite FG08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5</wicri:regionArea><wicri:noRegion>Ontario M4N 3M5</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:aff id="I2">Department of Psychiatry, University of Toronto, Suite FG08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Psychiatry, University of Toronto, Suite FG08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Hogan, David B" sort="Hogan, David B" uniqKey="Hogan D" first="David B" last="Hogan">David B. Hogan</name><affiliation wicri:level="4"><nlm:aff id="I3">Department of Medicine and The Hotchkiss Brain Institute, University of Calgary, HSC-3330 Hospital Dr. NW, Calgary, Alberta T2N 4N1, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Medicine and The Hotchkiss Brain Institute, University of Calgary, HSC-3330 Hospital Dr. NW, Calgary, Alberta T2N 4N1</wicri:regionArea><orgName type="university">Université de Calgary</orgName><placeName><settlement type="city">Calgary</settlement><region type="state">Alberta</region></placeName></affiliation></author></analytic><series><title level="j">Alzheimer's Research & Therapy</title><idno type="eISSN">1758-9193</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>While there have been no new medications approved for the treatment of Alzheimer's disease (AD) or other dementias in Canada since 2004, the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD) reviewed and updated the clinical practice guidelines on the pharmacological management of dementia that were published previously.</p></sec><sec><title>Methods</title><p>This review focused on the literature for the pharmacological treatment of dementia based on studies published since the third CCCDTD in 2006. A literature search of English-language medical databases was preformed for studies pertaining to the pharmacological treatment of AD and other dementias that examined the management of cognitive and functional impairment, as well as neuropsychiatric symptoms. All previous recommendations were reviewed, and only those that required updating based on new published studies were revised. Several new recommendations were also added. Recommendations were rated for quality of evidence and were approved by consensus.</p></sec><sec><title>Results</title><p>There were 15 revised or new recommendations approved by consensus. The revised recommendations included acknowledging that cholinesterase inhibitors (ChEIs) possess a class effect and any of the agents can be used for AD across the spectrum of severity and with co-existing cerebrovascular disease. There was insufficient evidence to recommend for or against the use of ChEIs in combination with memantine for the primary indication of treating neuropsychiatric symptoms, or for the treatment of vascular dementia. Recommendations for the discontinuation of cognitive enhancers were revised and clarified, as well as the risks associated with discontinuing these drugs. ChEIs were recommended as a treatment option for dementia with Parkinson's disease. Risks associated with use of antipsychotics for neuropsychiatric symptoms were strengthened, and guidelines regarding the use of antidepressants for affective disturbances in dementia were weakened, and are now considered an option but not a firm recommendation. Valproate was recommended not to be used, and there was insufficient evidence to recommend for or against the use of selective serotonin reuptake inhibitors or trazodone for the treatment of agitation and aggression.</p></sec><sec><title>Conclusion</title><p>In spite of the lack of new therapeutic agents for the treatment of dementia, recent studies have helped to clarify and strengthen recommendations to optimize the pharmacological management of these illnesses.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ferri, Cp" uniqKey="Ferri C">CP Ferri</name></author><author><name sortKey="Prince, M" uniqKey="Prince M">M Prince</name></author><author><name sortKey="Brayne, C" uniqKey="Brayne C">C Brayne</name></author><author><name sortKey="Brodaty, H" uniqKey="Brodaty H">H Brodaty</name></author><author><name sortKey="Fratiglioni, L" uniqKey="Fratiglioni L">L Fratiglioni</name></author><author><name 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uniqKey="Woloshin S">S Woloshin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Herrmann, N" uniqKey="Herrmann N">N Herrmann</name></author><author><name sortKey="Chau, Sa" uniqKey="Chau S">SA Chau</name></author><author><name sortKey="Kircanski, I" uniqKey="Kircanski I">I Kircanski</name></author><author><name sortKey="Lanctot, Kl" uniqKey="Lanctot K">KL Lanctôt</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Canada</li></country><region><li>Alberta</li><li>Ontario</li></region><settlement><li>Calgary</li><li>Toronto</li></settlement><orgName><li>Université de Calgary</li><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><noRegion><name sortKey="Herrmann, Nathan" sort="Herrmann, Nathan" uniqKey="Herrmann N" first="Nathan" last="Herrmann">Nathan Herrmann</name></noRegion><name sortKey="Herrmann, Nathan" sort="Herrmann, Nathan" uniqKey="Herrmann N" first="Nathan" last="Herrmann">Nathan Herrmann</name><name sortKey="Hogan, David B" sort="Hogan, David B" uniqKey="Hogan D" first="David B" last="Hogan">David B. Hogan</name><name sortKey="Lanctot, Krista L" sort="Lanctot, Krista L" uniqKey="Lanctot K" first="Krista L" last="Lanctôt">Krista L. Lanctôt</name><name sortKey="Lanctot, Krista L" sort="Lanctot, Krista L" uniqKey="Lanctot K" first="Krista L" last="Lanctôt">Krista L. Lanctôt</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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