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From the Department of Neurology (Dr. Doody), Baylor College of Medicine, Houston, TX; Lutheran Medical Office (Dr. Stevens), Fort Wayne, IN; Department of Geriatrics (Dr. Beck), College of Medicine, University of Arkansas for Medical Sciences, Little Rock; Department of Neurology (Dr. Dubinsky), University of Kansas Medical Center, Kansas City; Departments of Neurology (Dr. Kaye), Oregon Health Sciences University and Portland Veterans Affairs Medical Center, Portland, OR; Duke University (Ms. Gwyther), Durham, NC; Mount Sinai School of Medicine and VA Medical Center (Dr. Mohs), Bronx, NY; Department of Neurosciences (Dr. Thal), University of California at San Diego; Departments of Neurology (Dr. Whitehouse), Case Western Reserve University and University Hospitals of Cleveland, OH; Departments of Neurology and Psychiatry (Dr. DeKosky), University of Pittsburgh, PA; Departments of Neurology and Psychiatry & Biobehavioral Science (Dr. Cummings), University of California at Los Angeles.
Address correspondence and reprint requests to the Quality Standards Subcommittee, American Academy of Neurology, 1080 Montreal Ave., St. Paul, MN 55116.
OBJECTIVE: To define and investigate key issues in the management of dementia and to make literature-based treatment recommendations.
METHODS: 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?
RESULTS: 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).
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