Management of Dementia

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Contents

  1. Five strategies for better management of dementia patients | The Advisory Board Company
  2. Clinical Practice Guidelines for Management of Dementia
  3. Medicines to treat dementia

As expected, the clinical characteristics showed serious clustering, and sociodemographic variables, such as sex, age, and living status, were not GP-dependent. The per-protocol analyses, sensitivity analyses, and the intraclass correlations for the main outcomes are reported in eTable 4 in Supplement 2. In our study, DCM was beneficial for optimizing treatment and care in patients with dementia. We found medium to large effects of DCM for community-dwelling patients with dementia in primary care on behavioral and psychological symptoms, caregiver burden, and pharmacologic treatment with antidementia drugs.

Referring to neuropsychiatric symptoms measured by the Neuropsychiatric Inventory, a decrease in 4 points would be regarded as clinically meaningful. The study methods were in line with the demand to use standardized sets of outcome measures 20 and well-defined interventions 19 to improve comparability across studies, and our results contribute empirical evidence to currently inconclusive research 18 on DCM approaches in primary care. The results suggest that DCM increased the quality of dementia care. Improvements included a higher use of antidementia drugs.

Although this is a simple proxy for good medical dementia care, the data do not indicate whether drug treatment conformed to guidelines.

Five strategies for better management of dementia patients | The Advisory Board Company

To our knowledge, there is no benchmark for the percentage of people who should be treated with antidementia drugs in primary care that we could have used for comparison. This proportion is comparable with other studies. Neuropsychiatric symptoms and caregiver burden are among the most important risk factors for institutionalization of people with dementia.

This could save long-term costs. A small effect on quality of life was restricted to patients not living alone. This result should not be overestimated because validity and reliability of quality of life measures in people with dementia are limited. However, this finding implies that further analyses could identify target groups with an increased benefit. We speculate that the effectiveness of DCM could be associated with socioeconomic status, functional ability, or severity of dementia.

This is unexpected because comprehensive medication management was part of the intervention. We speculate that the intensity was probably too low in this trial because recommendations to the GP regarding pharmacologic treatment were provided only once. An effective reduction of PIMs may require a higher intensity of care management and follow-up reviews. Screening and recruitment were part of routine care so that selection bias cannot be ruled out.

However, all participating GPs agreed to recruit systematically while adhering to the requirements of the study design.


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The number of participants was imbalanced between the intervention and control groups. Fewer GPs were randomized to the control group. Furthermore, there was the tendency that GPs in the control group included less patients. We expect that during the trial, GPs noticed their assignment, which resulted in a loss of motivation for an inclusion of further patients.

Clinical Practice Guidelines for Management of Dementia

However, there were no significant group differences according to primary outcomes or sociodemographic variables. The DelpHi trial was not a diagnostic trial. The identification of patients with dementia was based on a screening instrument. A state-of-the-art diagnostic procedure was not required. However, the DemTect was designed for this specific purpose and is widely used in routine care. The study was incorporated into routine care as closely as possible so that the external validity of the results is high.

Non-pharmacological treatments

However, because of the rigorous design in the context of this trial, there were restrictions in time, length, and content of DCM activities. In routine care, nurses have more freedom to decide what, when, and how activities are performed. Additionally, generalizability might be limited because of the region and health care system being studied. It is possible that differences in access and availability of health care resources in other health care systems may affect the effectiveness. However, challenges of dementia care are mainly triggered by the disease itself and require similar resources that are available in different regions and health systems.

Dementia care management provided by specially trained nurses and supported by a computer-based IMS is an effective and safe collaborative care model that has clinically relevant patient- and caregiver-related effects on treatment and care. Therefore, implementation in routine care could be beneficial for people with dementia and their relative caregivers. Further analyses should identify specific subgroups of people with dementia with higher effectiveness of DCM and should evaluate cost-effectiveness to adapt DCM to other settings and health care systems. Published Online: July 26, Author Contributions: Drs Hoffmann and Thyrian had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Critical revision of the manuscript for important intellectual content: All authors. Administrative, technical, or material support: Thyrian, Eichler, Zwingmann, Kilimann. Conflict of Interest Disclosures: None reported.

Medicines to treat dementia

All persons mentioned were compensated for their contributions as part of their employment. All Rights Reserved.


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Compass: Treatment of dementia

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