Diagnosis and treatment of dementia: 6. Management of severe Alzheimer disease

Herrmann, Nathan; Gauthier, Serge
December 2008
CMAJ: Canadian Medical Association Journal;12/2/2008, Vol. 179 Issue 12, p1279
Academic Journal
Background: The management of severe Alzheimer disease often presents difficult choices for clinicians and families. The disease is characterized by a need for full-time care and assistance with basic activities of daily living. We outline an evidence-based approach for these choices based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. Methods: We developed evidence-based guidelines using systematic literature searches, with specific criteria for the selection and quality assessment of articles, and a clear and transparent decision-making process. We selected articles published from January 1996 to December 2005 that dealt with the management of severe Alzheimer disease. Subsequent to the conference, we searched for additional articles published from January 2006 to March 2008 using the same search terms. We graded the strength of the evidence using the criteria of the Canadian Task Force on Preventive Health Care. Results: We identified 940 articles, of which 838 were selected for further study. Thirty-four articles were judged to be of at least good or fair quality and were used to generate 17 recommendations. Assessment of severe Alzheimer disease should include the measurement of cognitive function and the assessment of behaviour, function, medical status, nutrition, safety and caregiver status. Management could include treatment with a cholinesterase inhibitor or memantine, or both. Treatment of neuropsychiatric symptoms begins with nonpharmacologic approaches to addressing behavioural problems. Severe agitation, aggression and psychosis, which are potentially dangerous to the patient, the caregiver and others in the environment, can be treated with atypical antipsychotics, with consideration of their increased risk of cerebrovascular events and death. All pharmacologic approaches require careful monitoring and periodic reassessment to determine whether continued treatment is necessary. Caregiver support and use of community resources are essential.


Related Articles

  • FAST STATS.  // Healthcare Purchasing News;Nov2010, Vol. 34 Issue 11, p6 

    The article presents statistics on the health care industry including statistics on hospitals' use of evidence-based treatments, the success rates of hospital treatments for pneumonia and hospitals' compliance with providing fibrinolytic therapy to heart attack patients.

  • CHOLINESTERASE INHIBITORS AND MEMANTINE: BEST PRACTICES. Doody, Rachelle S. // Primary Psychiatry;Oct2008 Expert Review Supplement, Vol. 15 Issue Suppl. 6, p34 

    The article focuses on evidence-based best practices guidelines in the application of cholinesterase inhibitors and memantine for the treatment of mild, moderate and severe Alzheimer's disease (AD). It offers information on the American Academy of Neurology Management of Dementia Guidelines....

  • Pharmacological treatment of neuropsychiatrie symptoms in Alzheimer's disease: a systematic review and meta-analysis. Jun Wang; Jin-Tai Yu; Hui-Fu Wang; Xiang-Fei Meng; Chong Wang; Chen-Chen Tan; Lan Tan // Journal of Neurology, Neurosurgery & Psychiatry;Jan2015, Vol. 86 Issue 1, p101 

    Background A wide variety of pharmacological agents are used in the management of neuropsychiatric symptoms, which are common in Alzheimer's disease (AD), but results from randomised controlled trials (RCTs) on the efficacy and safety of these agents are conflicting. Objectives To quantify the...

  • Draft of co-occurring report has evidence-based focus.  // Behavioral Health Accreditation & Accountability Alert;Aug2002, Vol. 7 Issue 8, p4 

    Provides information on a draft report on evidence-based treatments for co-occurring mental health and substance use disorders to be submitted by the U.S. Substance Abuse and Mental Health Services Administration to the U.S. Congress in fall 2002. Information on a plan outlined in the draft...

  • Confronting the hierarchy of evidence. Bower, Pete // Healthcare Counselling & Psychotherapy Journal;Oct2007, Vol. 7 Issue 4, p16 

    The article focuses on the medical model in context of research, as studied by the author. He says that the term "medical model" is associated with a philosophical assumption that there is a physical and biological basis to health and disease. He informs that evidence-based medicine was...

  • Time for evidence-based cytology. Dey, Pranab // CytoJournal;2007, Vol. 4 Issue 1, p1 

    Evidence-based medicine (EBM) is a fashionable and an extremely hot topic for clinicians, patients and the health service planners. Evidence-based cytology (EBC) is an offshoot of EBM. The EBC is concerned with generating a reproducible, high quality and clinically relevant test result in the...

  • Improving the Quality of Care – Can We Practice What We Preach? Steinberg, Earl P. // New England Journal of Medicine;6/26/2003, Vol. 348 Issue 26, p2681 

    The author comments on a study which examined the content of health care provided to adults in the U.S. between 1996 and 1998. He mentioned the variation in actual medical practice and evidence-based best practice. He described the administration of health care in the country. The author noted...

  • Economic evaluations in evidence based healthcare. Barrett, Barbara; Byford, Sarah // Evidence Based Mental Health;May2009, Vol. 12 Issue 2, p36 

    The article focuses on economic evaluations, its importance, and the reasons for its implementation in evidence-based healthcare. It states that the said evaluation is being conducted along with clinical evaluations to allow clinicians have knowledge on effectiveness and cost-effectiveness of...

  • Evidence-Based Medicine as a Sales Strategy.  // Pharmaceutical Representative;Mar2011, Vol. 41 Issue 3, p26 

    The article discusses the application and benefits of evidence-based medicine (EBM) as a sales strategy in the pharmaceutical industry. It presents several core elements of EBM including relevant search, clinical expertise, and patient-centric healthcare management. Also discussed are the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics