Table 4 Statements & recommendations for Dementia
From: Guidelines for dementia or Parkinson’s disease with depression or anxiety: a systematic review
Anxiety | |
Patients with Dementia should be assessed for Anxiety (e.g. HADS). | |
Level of Evidence | AIAQS Level D (Expert Opinion) |
Guidelines | |
Psychological Interventions can be considered for Anxiety in Dementia | |
Guidelines | NICE (2011) [41] |
There is little evidence about the treatment of Anxiety in those with Dementia. Cholinesterase Inhibitors can be considered for treating Dementia-related behaviours, including anxiety. | |
Level of Evidence | AIAQS Level A (Meta-analysis or RCT) |
Guidelines | AIAQS (2010) [42] |
Depression | |
Patients experiencing Dementia should be evaluated for Depression, including possible secondary causes. | |
Level of Evidence | CRCD Level A (Useful), AIAQS Level D, WFSBP Grade 3 (Limited Evidence from Controlled Studies), EFNS GPP |
Guidelines | NICE (2011) [41], AIAQS (2010) [42], CRCD (2011) [43], Sorbi et al (2012) [45], Ihl et al. (2011) [44] |
Patients with Depression in Dementia should be evaluated for suicide risk, however evidence varies. | |
Level of Evidence | APA Level I (Substantial Clinical Confidence) or Inconclusive |
Guidelines | |
Use of a valid screening tool (e.g. CSDD, GDS, HADS or DMAS) for Depression is recommended. | |
Level of Evidence | AIAQS Level D to Good Practice Point, Low Quality Evidence, EFNS GPP/Class II (Prospective Study) |
Guidelines | Gelenberg et al. (2010) [39], AIAQS (2010) [42], Sorbi et al (2012) [45], Hort et al (2010) [47], Mitchell et al. (2013) [48] |
fMRI needs further study to determine its utility in Depression in the context of Dementia | |
Level of Evidence | CCCDT4 Grade 2C (Moderate Recommendation, Low Level Evidence) |
Guidelines | Gauthier et al. (2012) [50] |
Therapy for Depression in Dementia should include a variety of Non-pharmacologic options. | |
Level of Evidence | AIAQS Level C (Case-control, Cohort), APA Level II (Moderate Clinical Confidence) |
Guidelines | NICE (2011) [41], AIAQS (2010) [42], Gelenberg et al. (2010) [39], Mitchell et al. (2013) [48] |
Comment | These include: cognitive behavioural therapy, reminiscence therapy, multi-sensory stimulation, animal-assisted therapy, exercise, stimulation-oriented treatment (recreational or pleasurable activities), or improvements to a living situation. Consider the involvement of carers. |
Although evidence is mixed, a trial of Anti-depressants could be considered for Depression in Dementia. | |
Level of Evidence | CCCDT4 Grade 2A (Moderate Recommendation, High Level Evidence), EFNS Class IV (Un-blinded, Expert Opinion), WFSBP Grade 5 (Inconsistent Results), APA Level II (Moderate Clinical Confidence) |
Guidelines | Gauthier et al. (2012) [50], NICE (2011) [41], Sorbi et al (2012) [45], Gelenberg et al. (2010) [39], Ihl et al. (2011) [44], Dua et al (2011) [49] |
When choosing an anti-depressant (E.g. SSRIs, SNRIs or TCAs) it is important to consider the anticholinergic side effects. | |
Level of Evidence | EFNS Level B (Case-control, Cohort), EFNS Class IV (Un-blinded, Expert Opinion), APA Level I (Substantial Clinical Confidence) to APA Level II (Moderate Clinical Confidence), AIAQS Level B |
Guidelines | Gauthier et al. (2012) [50], NICE (2011) [41], Sorbi et al (2012) [45], Hort et al (2010) [47], Gelenberg et al. (2010) [39], AIAQS (2010) [42] |
Comment | SSRIs (Citalopram or Sertraline) and TCAs have similar efficacy, but TCAs are not recommended given anticholinergic effects. SSRIs appear to be better tolerated. Other agents such as bupropion, venlafaxine and mirtazapine may be effective. |
Stimulants can be considered for treatment of Depression in Dementia. | |
Level of Evidence | APA Level III (Depends on Individual Circumstances), AIAQS Level B (Case-control, Cohort) |
Guidelines | |
Cholinesterase Inhibitors can be considered for treating Dementia-related behaviours, including depression. | |
Level of Evidence | AIAQS Level A (Meta-analysis or RCT) |
Guidelines | AIAQS (2010) [42] |
ECT can be considered in certain cases for Depression in those with Dementia. | |
Level of Evidence | APA Level II (Moderate Clinical Confidence) |
Guidelines | Gelenberg et al. (2010) [39] |
Cholinesterase Inhibitors may improve neuropsychiatric symptoms in Lewy Body Disease | |
Level of Evidence | Level A (Meta-analysis or RCT) |
Guidelines | O’Brien et al (2011) [60] |