- Describe your topic.
- Topic Nomination: Dementia Diagnosis and Treatment Suggested Key Questions: 1) In adult patients with suspected mild cognitive impairment (MCI) or dementia, what is the comparative effectiveness and utility of diagnostic testing (ie: blood tests, imaging, neurocognitive testing, functional testing). 2) In adult patients with MCI, what are the benefits and harms of pharmacologic therapies for decreasing symptoms, slowing progression, and improving function? 3) In adult patients with dementia, what are the benefits and harms of pharmacologic therapies for decreasing cognitive and behavioral symptoms and improving function? 4) In adult patients with moderate/late dementia, what are the benefits and harms of continuing, tapering or discontinuing pharmacologic therapy for both cognition and behaviors? 5) In adult patients with MCI, what are the benefits and harms of nonpharmacologic therapies for decreasing symptoms and improving function? 6) In adult patients with dementia, what are the benefits and harms of nonpharmacologic therapies for decreasing symptoms and improving function? 7) In adult patients with dementia, what is the comparative effectiveness of FDA approved and non-FDA approved pharmacologic therapies? 8) What are the benefits, harms, and comparative effectiveness for pharmacologic (eg: antipsychotics, sedative hypnotics) and nonpharmacologic therapies for treating behavioral disturbance in dementia for patients and caregivers? Patient population: Adults patients age over 65 with mild cognitive impairment or dementia Definition: • Mild Cognitive Impairment: Impairment of memory or other cognitive functions with slight or no effect on functional ability. • Dementia: Clinical syndrome of acquired impairment of memory, cognition, or language abilities, sufficient to impact functional ability. Special populations: Patients with multiple comorbidities, adult patients with different types of dementia (vascular, frontotemporal, Alzheimer, Parkinson’s), harms/benefits for different populations based on sex, race, ethnicity, and age group.
- Describe why this topic is important.
- Cognitive impairment becomes increasingly prevalent with advancing age and the United States is facing an unprecedented growth in the number of older adults. By 2020, the CDC estimates that older adults will account for approximately 20% of the US population.1 The prevalence of dementia ranges from 5 to 7%. Dementia is a syndrome comprising functional and cognitive decline and exists on a spectrum of mild to severe. There are a variety diagnostic tests available for the evaluation of cognitive impairment but there is limited data on the comparative effectiveness and utility of these tests. There are multiple pharmacologic and nonpharmacologic treatments targeted towards improving function, slowing cognitive decline, and controlling behavioral symptoms in patients with mild cognitive impairment and dementia. 1. Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. 2. Sosa-Ortiz AL, Acosta-Castillo I, Prince MJ. Epidemiology of dementias and Alzheimer's disease. Arch Med Res 2012; 43:600.
- Tell us why you are suggesting this topic.
- There have been a couple of recent reports, but neither addressed the specific questions outlined above. A systematic review of diagnosis and management strategies in the setting of mild cognitive impairment and dementia would provide insight for treating clinicians to improve care for this population.
- Target date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- The AAFP and ACP developed a joint guideline on dementia in 2008. This evidence report would be used to update that guideline. Additionally, articles and other resources on the AAFP website on this topic may be revised to incorporate the updated evidence.
- How will you or your group use the information from a new evidence report?
- The evidence from this report will be used to develop an evidence based clinical practice guideline from the American Academy of Family Physicians.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- We would use the evidence report to inform the development of a clinical practice guideline and implementation tools, and/or patient education. The AAFP disseminates new clinical practice guidelines through open access on our website, news stories, editorials, and social media. We also submit guidelines to the National Guideline Clearinghouse. We would disseminate information to key stakeholders, which would include other medical specialty societies, patient advocacy groups, patients, primary care physicians, etc.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- We have not been in contact with any organizations to date, but would reach out to key stakeholders to potentially participate in the guideline development process if this topic was accepted.
- Information About You:
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- Provide a description of your role or perspective
- Professional Society
- If you are you making a suggestion on behalf of an organization, please state the name of the organization
- American Academy of Family Physicians
- Please tell us how you heard about the Effective Health Care Program
- The AAFP has a long-standing partnership with the EHC Program. This program is an essential part for our guideline development program.
