Diagnosis and treatment of dementia: 5. Nonpharmacologic and pharmacologic therapy for mild to moderate dementia.
BACKGROUND
Practising physicians frequently seek advice on the most effective interventions for dementia. In this article, we provide practical guidance on nonpharmacologic and pharmacologic interventions for the management of mild to moderate dementia 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 mild to moderate stages of Alzheimer disease and other forms of dementia. Recommendations based on the literature review were drafted and voted on. Consensus required 80% or more agreement by participants. Subsequent to the conference, we searched for additional articles published from January 2006 to April 2008 using the same major keywords and secondary search terms. We graded the strength of the evidence using the criteria of the Canadian Task Force on Preventive Health Care.


RESULTS
We identified 1615 articles, of which 954 were selected for further study. From a synthesis of the evidence in these studies, we made 48 recommendations for the management of mild to moderate dementia (28) and dementia with a cerebrovascular component (8) as well as recommendations for addressing ethical issues (e.g., disclosure of the diagnosis) (12). The updated literature review did not change these recommendations. An exercise program is recommended for patients with mild to moderate dementia. Physicians should decide whether to prescribe a cholinesterase inhibitor on an individual basis, balancing anticipated benefits with the potential for harm. For mild mood and behavioural concerns, nonpharmacologic approaches should be considered first.


CONCLUSIONS
Although the available therapies for dementia can help with the management of symptoms, there is a need to develop more effective interventions.
Hogan
David B
DB
Department of Clinical Neurosciences, Health Sciences Centre, University of Calgary, 3330 Hospital Dr. NW, Calgary, ABT2N4N1. dhogan@ucalgary.ca
Bailey
Peter
P
Black
Sandra
S
Carswell
Anne
A
Chertkow
Howard
H
Clarke
Barry
B
Cohen
Carole
C
Fisk
John D
JD
Forbes
Dorothy
D
Man-Son-Hing
Malcolm
M
Lanctôt
Krista
K
Morgan
Debra
D
Thorpe
Lilian
L
D001007:Anxiety / Q000188:drug therapy / Q000209:etiology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003704:Dementia / Q000150:complications / Q000628:therapy*; D003858:Dependency, Psychological; D003863:Depression / Q000209:etiology / Q000628:therapy; D015259:Dopamine Agents / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D015444:Exercise; D006801:Humans; D008559:Memantine / Q000627:therapeutic use; D009483:Neuropsychological Tests; D009788:Occupational Therapy; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000628:therapy
D002800:Cholinesterase Inhibitors; D015259:Dopamine Agents; D008559:Memantine