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Society guideline links: Cognitive impairment and dementia

Society guideline links: Cognitive impairment and dementia

Introduction — This topic includes links to society and government-sponsored guidelines from selected countries and regions around the world. We will update these links periodically; newer versions of some guidelines may be available on each society's website. Some societies may require users to log in to access their guidelines.

The recommendations in the following guidelines may vary from those that appear in UpToDate topic reviews. Readers who are looking for UpToDate topic reviews should use the UpToDate search box to find the relevant content.

Links to related guidelines are provided separately. (See "Society guideline links: Delirium and confusional states in older adults".)

International

World Health Organization (WHO): Guidelines on risk reduction of cognitive decline and dementia (2019)

WHO: A guide towards a dementia plan (2018)

WHO: The global dementia observatory reference guide (2018)

Canada

Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD): Recommendations of the 5th Canadian Consensus Conference on the diagnosis and treatment of dementia (2020)

Choosing Wisely Canada: Don't recommend percutaneous feeding tubes in patients with advanced dementia; instead offer oral feeding (2020)

Choosing Wisely Canada: Don't use antipsychotics as first choice to treat behavioural and psychological symptoms of dementia (2020)

Canadian Task Force on Preventive Health Care (CTFPHC): Recommendations on screening for cognitive impairment in older adults (2015)

Alzheimer Society of Canada (ASC): Guidelines for care – Person-centred care of people with dementia living in care homes (2011)

United States

American Academy of Neurology (AAN): Practice parameter: Evaluation and management of driving risk in dementia, update (2010, reaffirmed 2022)

AAN: Practice guideline on mild cognitive impairment, update (2018, reaffirmed 2021)

Choosing Wisely: Don't prescribe antipsychotic medications for behavioral and psychological symptoms of dementia (BPSD) in individuals with dementia unless management of underlying causes fails to respond to best treatment practices. Only use for symptoms that severely impact quality of life or safety from self and/or others, in lowest dose possible and with frequent re-assessment for necessity and efficacy (2013, updated 2021)

American College of Radiology (ACR)-American College of Nuclear Medicine (ACNM)-American Society of Neuroradiology (ASNR)-Society of Nuclear Medicine and Molecular Imaging (SNMMI): Practice parameter for brain PET/CT imaging in dementia (2015, revised 2020)

US Preventive Services Task Force (USPSTF): Final recommendation statement on cognitive impairment in older adults – Screening (2020)

ACR: ACR Appropriateness Criteria on dementia (2019)

Choosing Wisely: Don't use physical or chemical restraints, outside of emergency situations, when caring for long-term care residents with dementia who display behavioral and psychological symptoms of distress; instead assess for unmet needs or environmental triggers and intervene using non-pharmacological approaches as the first approach to care whenever possible (2018)

American Psychiatric Association (APA): Practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia (2016)

Choosing Wisely: Don't assume a diagnosis of dementia in an older adult who presents with an altered mental status and/or symptoms of confusion without assessing for delirium or delirium superimposed on dementia using a brief, sensitive, validated assessment tool (2016)

Choosing Wisely: Don't order APOE genetic testing as a predictive test for Alzheimer disease (2015, updated 2016)

ACR: ACR Appropriateness Criteria on dementia and movement disorders (2015)

Choosing Wisely: Don't prescribe cholinesterase inhibitors for dementia without periodic assessment for perceived cognitive benefits and adverse gastrointestinal effects (2014, revised 2015)

Choosing Wisely: Don't routinely use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia (2013, revised 2015)

Choosing Wisely: Don't use antipsychotics as the first choice to treat behavioral and psychological symptoms of dementia (2015)

American Geriatrics Society (AGS): Feeding tubes in advanced dementia position statement (2014)

Choosing Wisely: Don't recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral assisted feeding (2013)

Choosing Wisely: Don't use PET imaging in the evaluation of patients with dementia unless the patient has been assessed by a specialist in this field (2013)

National Institute on Aging (NIA)-Alzheimer's Association (ALZ): Guidelines for the neuropathologic assessment of Alzheimer's disease – A practical approach (2012)

American Psychological Association (APA): Guidelines for the evaluation of dementia and age-related cognitive change (2011)

Europe

European Association of Nuclear Medicine (EANM) and European Academy of Neurology (EAN): Recommendations for the use of brain 18F-fluorodeoxyglucose positron emission tomography in neurodegenerative cognitive impairment and dementia – Delphi consensus (2018)

European Federation of Neurological Societies (EFNS)-European Neurological Society (ENS)/EAN: Guideline on concomitant use of cholinesterase inhibitors and memantine in moderate to severe Alzheimer's disease (2015)

EFNS-ENS: Guidelines on the diagnosis and management of disorders associated with dementia (2012)

EFNS: Guidelines for the diagnosis and management of Alzheimer's disease (2010)

United Kingdom

Choosing Wisely UK: Royal Pharmaceutical Society – Stop the inappropriate use of antipsychotics to manage behaviour that challenges in people with learning disabilities, dementia and other mental health conditions (2019)

National Institute for Health and Care Excellence (NICE): Quality standard on dementia (2019)

Choosing Wisely UK: Royal College of Psychiatrists – Aim to use non-drug treatments for the management of behavioural and psychological symptoms of dementia. If there are significant risks that make treatment with an antipsychotic necessary, this should be discussed with the patient and their family, and the lowest possible dose used (2018)

Choosing Wisely UK: Royal College of Psychiatrists – Antipsychotics can cause serious side effects in patients with Lewy Body Dementia. They should only be used under expert guidance. Severe sensitivity to both typical and atypical antipsychotic medication occurs in approximately 50% of individuals with Lewy Body Dementia (2018)

Choosing Wisely UK: Royal College of Psychiatrists – Cognitive testing alone does not diagnose dementia. In order to establish an accurate diagnosis of dementia it is recommended to obtain a full history, collateral information from key family members and a cognitive assessment (2018)

Choosing Wisely UK: Royal College of Psychiatrists – Do not forget pain as a common cause of agitation in patients with dementia. 50% of people with dementia are estimated to experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause of behavioural symptoms, which can lead to inappropriate. Consider prescribing regular analgesia such as paracetamol if there is clinical suspicion that pain is a relevant trigger (2018)

NICE: Guideline on dementia – Assessment, management, and support for people living with dementia and their carers (2018)

Choosing Wisely UK: Royal College of General Practitioners – Being alert to the possibility of dementia in patients at risk, with further assessment on an individual basis is good practice, but routinely screening for dementia using structured tools has not been recommended by the UK National Screening Council. It risks false positive diagnoses and has no proven benefit (2016)

NICE: Guideline on dementia, disability, and frailty in later life – Mid-life approaches to delay or prevent onset (2015)

Australia-New Zealand

Australian National Health and Medical Research Council (NHMRC): Clinical practice guidelines and principles of care for people with dementia – Recommendations (2016)

Choosing Wisely Australia: Do not use antipsychotics as the first choice to treat behavioural and psychological symptoms of dementia (2016)

Choosing Wisely Australia: Don't initiate and continue antipsychotic medicines for behavioural and psychological symptoms of dementia for more than 3 months (2016)

Japan

[In Japanese] Choosing Wisely Japan: Tube feeding for Alzheimer's disease patients – When necessary and when not needed (2017)

[In Japanese] Japanese Society of Neurology (JSN): Guidelines for the management of dementia disease (2017)

Topic 116344 Version 15.0