Hostname: page-component-7dd5485656-kp629 Total loading time: 0 Render date: 2025-10-29T14:41:13.418Z Has data issue: false hasContentIssue false
  • English
  • Français

The Recognition, Assessment and Management of Dementing Disorders: Conclusions from the Canadian Consensus Conference on Dementia

Published online by Cambridge University Press:  02 December 2014

C. Patterson ,
A. Grek ,
S. Gauthier ,
H. Bergman ,
C. Cohen ,
J.W. Feightner ,
H. Feldman  and
D.B. Hogan
C. Patterson
Affiliation:
Department of Medicine, McMaster University, Hamilton, ON, Canada
A. Grek
Affiliation:
Department of Psychiatry, McMaster University, Hamilton, ON, Canada
S. Gauthier
Affiliation:
McGill Centre for Studies in Aging, McGill University Montreal, QC, Canada
H. Bergman
Affiliation:
Division of Geriatric, Medicine, McGill University Montreal, QC, Canada
C. Cohen
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, ON, Canada
J.W. Feightner
Affiliation:
Department of Family Medicine, University of Western, Ontario, London, ON, Canada
H. Feldman
Affiliation:
Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
D.B. Hogan
Affiliation:
Division of Geriatric Medicine, University of Calgary, Calgary, AB, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

i) To develop evidence based consensus statements on which to build clinical practice guidelines for primary care physicians towards the recognition, assessment and management of dementing disorders; ii) to disseminate and evaluate the impact of these statements and guidelines built on these statements.

Options:

Structured approach to assessment, including recommended laboratory tests, choices for neuroimaging and referral; management of complications (especially behaviour problems and depression) and use of cognitive enhancing agents.

Potential outcomes:

Consistent and improved clinical care of persons with dementia; cost containment by more selective use of laboratory investigations, neuroimaging and referrals; appropriate use of cognitive enhancing agents.

Evidence:

Authors of each background paper were entrusted to: perform a literature search, discover additional relevant material including references cited in retrieved articles; consult with other experts in the field and then synthesize information. Standard rules of evidence were applied. Based upon this evidence, consensus statements were developed by a group of experts, guided by a steering committee of eight individuals from the areas of Neurology, Geriatric Medicine, Psychiatry, Family Medicine, Preventive Health Care and Health Care Systems.

Values:

Recommendations have been developed with particular attention to the context of primary care and are intended to support family physicians in their ongoing assessment and care of patients with dementia.

Benefits, harms and costs:

Potential for improved clinical care of individuals with dementia. A dissemination and evaluation strategy will attempt to measure the impact of the recommendations.

Recommendations:

See text.

Validation:

Four other sets of consensus statements and/or guidelines have been published recently. These recommendations are generally congruent with our own consensus statements. The consensus statements have been endorsed by relevant bodies in Canada.

Sponsors:

Funding was provided by equal contributions from seven pharmaceutical companies and by a grant from the Consortium of Canadian Centres for Clinical Cognitive Research (C5R). Contributions were received from two Canadian universities (McGill, McMaster). Several societies supported delegates to the conference.

Information

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 28 , Supplement S1: Canadian Consensus Conference on Dementia , May 2001 , pp. S3 - S16
Copyright
Copyright © The Canadian Journal of Neurological 2001

References

References

1. Canadian Study of Health and Aging Working Group. CanadianStudy of Health and Aging: Study Methods and Prevalence of Dementia. Can Med Assoc J 1994; 150: 899–913.Google Scholar
2. Statistics Canada. Population aging and the elderly. Ottawa. 1993(1991 Census of Canada; Cat. No. 91-533E, 110).Google Scholar
3. Clarfield, AM. Canadian Consensus Conference on the Assessmentof Dementia. Montreal. Division of Geriatrics, SirMortimer, B. Davis – Jewish General Hospital, 3755 Côte Ste-Catherine. H3T 1E2. 1991 (Supplement to Can Med Assoc J 1991: 144).Google Scholar
4. Clarfield, AM. Assessing Dementia: The Canadian Consensus. CanMed Assoc J 1991; 144: 851–853.Google Scholar
5. Canadian Medical Association: Guidelines for Canadian ClinicalPractice Guidelines. Ottawa. Canadian Medical Association: 1994.Google Scholar
6. Woolf, SH, Battista, RN, Anerson, GM, Logan, AG, Wang, EEL. Assessing the clinical effectiveness of preventive manoeuvres: analytical principles and systematic methods in reviewing evidence and developing clinical practice recommendations. J Clin Epidemiol 1994; 43: 891–905.CrossRefGoogle Scholar
7. National Auxiliary Publications Service (NAPS) document no.05439. PO. Box 3513, Grant Central Station. New York, NY 10163–3513.Google Scholar
8. American Psychiatric Association. Diagnostic and StatisticalManual of Mental Disorders (DSM IV) 4th Edition. Washington, DC. American Psychiatric Association 1994.Google Scholar
9. McKhann, G, Drachman, DA, Folstein, M, et al. Clinical diagnosisof Alzheimer’s disease– report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984; 34:939–944.Google Scholar
10. Rockwood, K, Parhad, I, Hachinski, V, et al. Diagnosis of vasculardementia: Consortium of Canadian Centres for Clinical Cognitive Research Consensus Statement. Can J Neurol Sci 1994; 21:358–364.Google Scholar
11. Rockwood, K, Ebly, E, Hachinski, V, Hogan, D. Presence andtreatment of vascular risk factors in patients with vascular cognitive impairment. Arch Neurol 1994; 54: 33–39.Google Scholar
12. Kertesz, A, Davidson, W, Fox, H. Frontal lobe behavioural inventory:diagnostic criteria for frontal lobe dementia. Can J Neurol Sci 1997; 24:29–36.Google Scholar
13. McKeith, IB, Galasko, D, Kosaka, K. Consensus guidelines for theclinical and pathological diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology 1996; 47: 1113–1124.Google Scholar
14. Morris, JC, McKeel, DW Jr, Storandt, M, et al. Very mildAlzheimer’s disease: informant-based clinical, psychometric and pathologic distinction from normal aging. Neurology 1991; 41: 469.Google Scholar
15. Hänninen, T, Reinikainen, KJ, Kelkala, E-L, et al. Subjectivememory complaints and personality traits in normal elderly subjects. J Am Geriatr Soc 1994; 42: 1–4.Google Scholar
16. Jorm, AF, Christensen, H, Korten, AE, et al. Do cognitive complaintseither predict future cognitive decline or reflect past cognitive decline? A longitudinal study of an elderly community sample. Psychol Med 1997; 27(1): 91–98.Google Scholar
17. Larson, EB, Reifler, BV, Feathersone, HJ, English, DR. Dementia inelderly outpatients: a prospective study. Ann Intern Med 1984; 100:417–423.Google Scholar
18. Larson, EB, Reifler, BV, Sumi, SM, Canfield, CG, Chinn, NM. Diagnostic tests in the evaluation of dementia: a prospective study of the 200 elderly outpatients. Arch Intern Med 1986; 146: 1917–1922.Google Scholar
19. Fleming, KC, Adams, AC, Peterson, RC. Dementia: Diagnososis andEvaluation. Mayo Clin Proc 1995;70(11):1093–1107.Google Scholar
20. Clarfield, AM. The reversible dementias: do they reverse? AnnIntern Med 1988; 109: 476–486.Google Scholar
21. Lipowski, ZJ. Delirium in the elderly patient. N Engl J Med 1989; 320: 578–582.Google ScholarPubMed
22. Cummings, JL, Jarvik, LF. Dementia. In: Cassel, CK, Risenberg, DE,Sorensen, LB, Walsh, JR, eds. Geriatric Medicine (2nd Ed). New York. Springer-Verlag 1990; 443.Google Scholar
23. Folstein, MF, Folstein, SE, McHugh, PR. “Mini-Mental State”: apractical method of grading the cognitive state of patients for the clinician. J Psychiatric Res 1975; 12: 189–198.CrossRefGoogle Scholar
24. Stuss, DT, Meiran, N, Guzman, A, Lafleche, G, Willmer, J. Do longtests yield a more accurate diagnosis of dementia than short tests? Arch Neurol 1996; 53: 1033–1039.CrossRefGoogle ScholarPubMed
25. Pfeffer, RI, Kurosaki, TT, Harrah, CH. Measurement of functionalactivities in older adults in the community. J Gerontol 1982; 37: 323–329.Google Scholar
26. Hershey, LA, Jaffe, DF, Greenough, PG. Validation of cognitive andfunctional assessment instruments in vascular dementia. Int JPsychiatry Med 1987; 17: 183–192.Google Scholar
27. American Academyof NeurologyQuality StandardsSubcommittee: Practice parameter for diagnosis and evaluation of dementia. Neurology 1994; 44: 2203–2206.Google Scholar
28. Geldmacher, DS, Whitehouse, P. Evaluation of Dementia. N Engl JMed 1996; 335: 330–336.Google Scholar
29. Chui, H, Zhang, Q. Evaluation of dementia: a systematic study ofthe usefulness of the American Academy of Neurology’s practiceparameters. Neurology 1997; 49: 925–935.CrossRefGoogle Scholar
30. Frank, C. Dementia workup. Deciding on laboratory testing for theelderly. Can Fam Physician 1998; 44: 1489–1495.Google Scholar
31. Freter, S, Bergman, H, Gold, S, Chertkow, H, Clarfield, AM. Prevalence of potentially reversible dementias and actual reversibility in a memory clinic cohort. Can Med Assoc J 1998; 159: 657–662.Google Scholar
32. Amar, K, Lewis, T, Wilcock, G, Scott, M, Bucks, R. The relationshipbetween white matter low attenuation on brain CT and vascular risk factors: a memory clinic study. Age Ageing 1995; 24(5): 411–415.Google Scholar
33. Verhey, FR, Jolles, J, Ponds, RW, et al. Diagnosing dementia: acomparison between a monodisciplinary and a multidisciplinary approach. J Neuropsych Clin Neurosci 1993; 5(1): 78–85.Google Scholar
34. Wilson, JMC, Jungner, G. Principles and practice of screening fordisease. Public Health Paper No. 34. WHO. Geneva. 1968.Google Scholar
35. Ebly, EM, Hogan, DB, Parhad, IM. Cognitive impairment in the nondemented elderly. Arch Neurol 1995; 52: 612–619.Google Scholar
36. Tuokko, HA. Cognitive impairment with no dementia -yet? Themeaning of mild cognitive impairment in older adults. Mature Medicine Canada 2000; June-August: 116–118.Google Scholar
37. Hogan, DB, Ebly, M. Predicting who will develop dementia in acohort of Canadian seniors. Can J Neurol Sci 2000; 27:18–24.Google Scholar
38. Petersen, RC, Smith, GE, Waring, SC. Mild cognitive impairment.Clinical characterization and outcome. Arch Neurol 1999; 56: 303–308.Google Scholar
39. Ritchie, K, Touchon, J. Mild cognitive impairment: conceptual basisand current nosological status. Lancet 2000; 355: 225–228.Google Scholar
40. Kafonek, S, Ettinger, WH, Roca, R, et al. Instruments for screeningfor depression and dementia in a long-term care facility. J Am Geriatr Soc 1989; 37: 29–34.Google Scholar
41. Jorm, AF, Christensen, H, Henderson, AS, et al. Informant ratings ofcognitive decline of elderly people: relationship to longitudinal change on cognitive tests. Age Ageing 1996; 25(2) 125–129.Google Scholar
42. O’Connor, DW, Pollitt, PA, Hyde, JB, et al. Do general practitionersmiss dementia in elderly patients? Br Med J 1988; 297: 1107–1110.Google Scholar
43. Tombaugh, TN, McIntyre, NJ. The Mini-Mental State Examination:a comprehensive review. J Am Geriatr Soc 1992; 40: 922–935.Google Scholar
44. Brodaty, H, Clark, J, Banguli, M, et al. Screening for cognitiveimpairment in general practice: toward a consensus. AlzheimerDis Assoc Disord 1998; 12(1): 1–13.Google Scholar
45. Barberger-Gateau, P, Commenges, D, Gagnon, M, et al. Instrumentalactivities of daily living as a screening tool for cognitive impairment and dementia in elderly community dwellers. J Am Geriatr Soc 1992; 40: 1129–1134.Google Scholar
46. Patterson, C. Screening for cognitive impairment. In: The CanadianGuide to Clinical Preventive Health Care. Goldbloom, RB. ed. Canada Communications Group. Ottawa 1994; 902–911.Google Scholar
47. Screening for dementia. In: US Preventive Services Task Force:Guide to Clinical Preventive Services. 1996. Baltimore: Williamsand Wilkins. 531–540.Google Scholar
48. American Academy of Family Physicians. Age Charts for PeriodicHealth Examination. Kansas City, MO. American Academy of Family Physicians. 1994 (Reprint No. 510).Google Scholar
49. Blacker, D, Tanzi, RE. The genetics of Alzheimer Disease. ArchNeurol 1998; 55: 294–296.Google Scholar
50. Van Duijn, CM, Clayton, D, Chandra, V. Familial aggregation ofAlzheimer’s disease and related disorders: A collaborative re-analysis of case-control studies. Int J Epidemiol 1991; 20: S13–20.Google Scholar
51. Schupf, N, Kapell, D, Nightingale, B, et al. Earlier onset ofAlzheimer disease in men with Down’s syndrome. Neurology 1998; 50:991–995.Google Scholar
52. Tilvis, RS, Strandberg, TE, Juva, K. Apolipoprotein E phenotypes,dementia and mortality in a prospective population sample. J Am Geriatr Soc 1998; 46: 712–715.Google Scholar
53. Kukull, WA, Schellenberg, GD, Bowen, JD. Apolipoprotein E inAlzheimer’s disease risk and case detection. A case-control study. J Clin Epidemiol 1996; 49: 1143–1148.CrossRefGoogle ScholarPubMed
54. Post, SG, Whitehouse, PJ, Binstock, RH, et al. Consensus statement:the clinical introduction of genetic testing for Alzheimer’sdisease. J Am Med Assoc 1997; 277: 832–836.Google Scholar
55. Brookmeyer, R, Gray, S, Karras, C. Projections of Alzheimer’sdisease in the United States and the Public Health impact ofdelaying disease onset. Am J Publ Health 1998; 88(9): 1337–1342.Google Scholar
56. Sanderson, S. Hypertension in the elderly: pressure to treat? (Ameta-analysis of 1400 patients). Health Trends 1996; 28: 71–75.Google Scholar
57. Hebert, PR, Gaziano, JM, Chan, KS, Heunekens, CH. Cholesterollowering with statin drugs, risk of stroke and total mortality. An overview of randomized trials. JAMA 1997; 278: 313–321.Google Scholar
58. Bucher, HC, Griffith, LE, Guyatt, GH. Effect of HMGcoAreductaseinhibitors on stroke. A meta-analysis of randomized, controlledtrials. Ann Intern Med 1998; 128: 89–95.Google Scholar
59. Albers, GW, Sherman, DG, Gress, DR, Paulseth, JE, Petersen, P. Stroke prevention in nonvalvular atrial fibrillation: a review of prospective randomized trials. Ann Neurology 1991; 30: 511–518.Google Scholar
60. Skoog, I, Lernfelt, B, Landahi, S, et al. 15 year longitudinal study ofblood pressure and dementia. Lancet 1996; 347: 1141–1145.Google Scholar
61. Forette, F, Seux, M-L, Staessen, JA, et al. Prevention of Dementia inrandomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998; 32:1347–1351 Google Scholar
62. Brenner, DE, Kukull, W, Stergachis, A, et al. Postmenopausalestrogen replacement therapy and the risk of Alzheimer’s disease: a population-based case-control study. Am J Epidemiol 1994; 140: 262–267.Google Scholar
63. Mulnard, RA, Cotman, CW, Kawas, C, et al. Estrogen replacementtherapy for treatment of mild to moderate Alzheimer’s disease: a randomized controlled trial. Alzheimer’s Disease CooperativeStudy. JAMA 2000; 283(8):1007–1015.Google Scholar
64. Feig, DS. Prevention of osteoporotic fractures in women byestrogen replacement therapy. In: The Canadian Guide to Clinical Preventive Health Care. Goldbloom, RB, ed. Ottawa. Canada Communications Group 1994. 621–631.Google Scholar
65. Breitner, JCS. The role of anti-inflammatory drugs in the preventionand treatment of Alzheimer’s disease. Ann Rev Med 1996; 47: 401–411.Google Scholar
66. Canadian Study of Health and Aging Working Group. The Canadian Study of Health and Aging: Risk factors for Alzheimer’s disease in Canada. Neurology 1994; 44: 2073–2080.Google Scholar
67. Graves, AB, White, E, Koepsell, TD, et al. The association betweenhead trauma and Alzheimer’s disease. Am J Epidemiol 1990; 131: 491–501.CrossRefGoogle ScholarPubMed
68. Alzheimer Society of Canada. Tough issues: ethical guidelines. Toronto. Alzheimer Society of Canada. 1320 Young Street, Suite 201, M4T1X2. 1997 Google Scholar
69. Fisk, JD, Sadovnick, AD, Cohen, CA, et al. Ethical guidelines of theAlzheimer Society of Canada. Can J Neurol Sci 1998; 25: 242–248.Google Scholar
70. Cohen, D. A primary carechecklist for effective familymanagement. Med Clin North Am 1994; 78: 795–809.CrossRefGoogle Scholar
71. Drickamer, MA, Lachs, MS. Should patients with Alzheimer’sdisease be told their diagnosis? N Engl J Med 1992; 326: 947–951.Google Scholar
72. Drachman, DA, Swearer, JM. Driving and Alzheimer’s disease: therisk of crashes. Neurology 1993; 43: 2448–2456.CrossRefGoogle Scholar
73. Lundberg, C, Johansson, K, Ball, K, et al. Dementia and driving: anattempt at consensus. Alzheimer Dis Assoc Disord 1997; 11: 28–37.Google Scholar
74. Hunt, LA, Murphy, CF, Carr, D, et al. Reliability of the WashingtonUniversity Road Test. A performance based assessment for drivers with dementia of the Alzheimer type. Arch Neurol 1997; 54: 707–712.Google Scholar
75. Hemmelgarn, B, Suisa, S, Huang, A, Boivin, JF, Pinard, G. Benzodiazepine use and risk of motor vehicle crashes. JAMA 1997; 278: 27–31.Google Scholar
76. O’Connor, DW, Pollitt, PA, Brook, CPB, Reiss, BB. The validity ofinformant histories in a community study of dementia. Int JGeriatr Psychiatr 1989; 4: 203–208.Google Scholar
77. Schulz, R, O’Brien, AT, Bookwala, J, Fleissner, K. Psychiatric andphysical morbidity effects of dementia caregiving: prevalence, correlates and causes. Gerontologist 1995; 35: 771–791.Google Scholar
78. Mittelman, MS, Ferris, SH, Shulman, E, Steinberg, G, Levin, B. Afamily intervention to delay nursing home placement of patients with Alzheimer’s disease. A randomized controlled trial. JAMA 1996; 276: 1725–1731.Google Scholar
79. Pollitt, PA. Dementia in old age: an anthropological perspective. Psychol Med 1996; 26: 1061–1074.Google Scholar
80. Crum, RM, Anthony, JC, Bassett, SS, Folstein, MF. Population-basednorms for the Mini-Mental State Examination by age andeducational level. JAMA 1993; 269: 2386–2391.Google Scholar
81. Uhlman, RF, Larson, EB. Effects of education on the Mini-MentalState Examination as a screening test for dementia. J Am Geriatr Soc 1991; 39: 876–880.CrossRefGoogle Scholar
82. Martin, GM, Kukull, WA. Do cultural differences affect Alzheimer’sdisease? JAMA 1996; 276: 993–995.Google Scholar
83. Burns, A, Jacoby, R, Levy, R. Psychiatric phenomena of Alzheimer’sdisease III: Disorders of Mood. Br J Psychiatr 1990; 157: 81–86.Google Scholar
84. Brodaty, H, Luscombe, G. Depression in persons with dementia. IntPsychogeriatr 1996; 8: 609–622.Google Scholar
85. Wragg, RE, Jeste, DV. Overview of depression in Alzheimer’sdisease. Am J Psychiatr 1989; 145: 577–587 Google Scholar
86. Fisher, P, Simanyi, M, Danielczyk, W. Depression in dementia of theAlzheimer type and in multi-infarct dementia. Am J Psychiatry 1990; 147: 1484–1487.Google Scholar
87. Reifler, BV, Teri, L, Raskind, M, et al. Double-blind trial ofimipramine in Alzheimer’s disease with and without depression (see comments). Am J Psychiatry 1989; 146: 809–810.Google Scholar
88. Olafsson, K, Jorgensen, S, Jensen, HV, et al. Fluvoxamine in thetreatment of demented elderly patients: a double-blind, placebo-controlled study. Acta Psychiatr Scand 1982; 85: 453–456.Google Scholar
89. Flint, AJ. Pharmacologic treatment of depression in late life. CanMed Assoc J 1997; 157(8): 1061–1067.Google Scholar
90. Sunderland, T, Tariot, PN, Cohen, RM, et al. Anticholinergicsensitivity in patients with dementia of the Alzheimer type: a dose-response study. Arch Gen Psychiatry 1987; 44: 418–426.Google Scholar
91. Teri, L, Larson, EB, Reifler, BV. Behavioural disturbance indementia of the Alzheimer type. J Am Geriatr Soc 1988; 36: 1–6.Google Scholar
92. Nilsson, K, Palmerstierna, T, Wistedt, B. Aggressive behaviour inhospitalized psychogeriatric patients. Acta Psychiatr Scand 1988; 78:172–175.Google Scholar
93. Beck, CK, Shue, VM. Interventions for treating disruptive behaviourin demented elderly people. Nurs Clin North Am 1994; 29: 143–155.Google Scholar
94. Schneider, LS, Pollock, VE, Lyness, SA. A meta-analysis ofcontrolled trials of neuroleptic treatment in dementia. J AmGeriatr Soc 1990; 38: 553–563.Google Scholar
95. Finkel, SI, Lyons, JS, Anderson, RL. A randomized, placebo-controlled trial of thiothixene in agitated, demented nursing home patients. Int J Geriatr Psychiatr 1995; 10: 129–136.Google Scholar
96. Katz, IR, Jeste, DV, Mintzer, JE, et al. Comparison of risperidone andplacebo for psychosis and behavioural disturbances associated with dementia:a randomized,double-blind trial. J ClinPsychiatry 1999; 60:107–115.Google Scholar
97. De Deyn, PP, Rabheru, K, Rasmussen, A, et al. A randomized trial ofrisperidone, placebo and haloperidol for behavioural symptoms of dementia. Neurology 1999; 53:946–955.Google Scholar
98. Defilippi, JL, Crismon, ML. Antipsychotic agents in patients withdementia. Pharmacotherapy 2000; 20(1): 23–33.Google Scholar
99. Hoes, MJ. Recent developments in the management of psychoses. Pharm World Sci 1998; 20(3): 101–106.CrossRefGoogle Scholar
100. Anon.Treatment of specialpopulations with the atypicalantipsychotics. Collaborative Working Group on clinical trial evaluations. J Clin Psychiatry 1998; 59 (Suppl 12): 46–52.Google Scholar
101. Lawlor, BA, Radcliffe, J, Molchan, SE. A pilot placebo-controlledstudy of trazodone and buspirone in Alzheimer’s disease. Int JGeriatr Psychiatr 1994; 9: 55–59.Google Scholar
102. Tariot, PN. Treatment of strategies for agitation and psychosis indementia. J Clin Psychiatry 1996; 57 (Suppl 14): 21–29.Google Scholar
103. Mintzer, JE,Brawman-Mintzer, O. Agitation as a possibleexpression of generalized anxiety disorder in demented elderly patients: toward a treatment approach. J Clin Psychiatry 1996; 57(Suppl 7): 55–63.Google Scholar
104. Lovestone, S, Graham, N, Howard, R. Guidelines on drug treatmentsfor Alzheimer’s disease. Lancet 1997; 350: 232–233.Google Scholar
105. Rogers, SL, Farlow, MR, Doody, RS, Mohs, R, Friedhoff, LT and theDonepezil Study Group. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer’s disease. Neurology 1998; 50: 136–145.Google Scholar
106. Rogers, SL, Friedhoff, LT and the Donepezil Study Group. Theefficacy and safety of donepezil in patients with Alzheimer’s disease: results of a US multicenter, randomized, double blind, placebo-controlled trial. Dementia 1996; 7: 293–303.Google Scholar
107. Rogers, SL, Friedhoff, LT. Long-term efficacy and safety ofdonepezil in the treatment of Alzheimer’s disease: An interim analysis of the results of a US multicentre open label extension study. Eur Neuropsychopharmacol 1998.Google Scholar
108. Feldman, H, Gauthier, S, Hecker, J, et al and the Donepezil MSADStudy Group. Benefits of donepezil on global function, behaviour, cognition and ADLs in patients with moderate-to-severe Alzheimer’s disease. Neurology. 2000; 54(3); A469.Google Scholar
109. Corey-Bloom, J, Anand, R, Vach, J for the ENA 713 B352 StudyGroup. A randomized trial evaluating the efficacy and safety of ENA 713 (rivastigmine tartrate), a new acetylcholinesterase inhibitor, in patients with mild to moderately severe Alzheimer’s disease. Int J Geriatr Psychopharmacol 1998; 1: 55–65.Google Scholar
110. Rösler, M, Anand, R, Cicin-Sain, A, et al on behalf of the B303Exelon Study Group. Efficacy and safety of rivastigmine (Exelon) in patients with Alzheimer’s disease: internationalrandomized controlled trial. Br Med J 1999; 318: 633–640.Google Scholar
110a. Birks, J, GrimleyEvans, J, Iakovidou, V, Tsolaki, M. Rivastigmine for Alzheimer’s disease (Cochrane Review). Cochrane Database Syst Rev 2000;4:CD001191.Google Scholar
111. Kanowski, S, Herrmann, WM, Stephen, K, et al. Proof of efficacy ofthe ginkgo biloba special extract Egb 761 in outpatients suffering from mild to moderate primary degenerative dementia of the Alzheimer type of multi-infarct dementia. Pharmacopsychiatry 1996; 29:47–56.Google Scholar
112. LeBars, PL, Katz, MM, Berman, N, et al. A placebo-controlled,double-blind, randomized trial of an extract of ginkgo biloba for dementia. JAMA 1997; 278: 1327–1332.Google Scholar
113. Sano, M, Ernesto, C, Thomas, RG, et al. A controlled trial ofselegiline, alpha-tocopherol or both as treatment for Alzheimer ’s disease. The Alzheimer’s Disease Cooperative Study. N Eng J Med 1997; 336: 1216–1222.Google Scholar
114. Small, GW, Rabins, PV, Barry, PP, et al. Diagnosis and Treatment ofAlzheimer’s Disease and Related Disorders. Consensus Statement of the American Association for Geriatric Psychiatry, the A l z h e i m e r’s Association, and the American Geriatrics Society. JAMA 1997; 278: 1363–1371.Google Scholar
115. American Psychiatric Association. Practice Guideline for thetreatment of patients with A l z h e i m e r’s disease and other dementia of late life. Am J Psychiatry 1997; 154: Suppl 1–39.Google Scholar
116. Costa, PT Jr, Williams, TF, Somerfield, M, et al. Clinical PracticeGuideline No. 19, Rockville MD. AHCPR Publication. No. 970702, 1996.Google Scholar
117. Hayward, RSA. Clinical practice guidelines on trial. Can MedAssoc J 1997; 156: 1725–1727.Google Scholar
118. Erkinjuntti, T, Ostbye, T, Steenhuis, R, Hachinsky, V. The effect ofdifferent diagnostic criteria on the prevalence of dementia. NEngl J Med 1997; 337: 1667–1674.Google Scholar

References

1. Sano, M, Ernesto, C, Thomas, RG, et al. A controlled trial of selegiline alpha-tocopherol, or both as treatment for Alzheimer’s disease. N Engl J Med 1997; 336: 1216–1222.Google Scholar
2. Meyers, DG, Maioley, PA, Weeks, D. Safety of antioxidant vitamins. Arch Intern Med 1996; 156: 925–935.Google Scholar
3. Blot, WJ. Vitamin/mineral supplementation and cancer risk - international chemoprevention trials. Proc Soc Exp Biol Med 1997; 216: 291–296.Google Scholar
4. Patterson, RE, White, E, Kristal, AR, Neuhouser, ML, Patten, JD. Vitamin supplements and cancer risk. Cancer Causes Control 1997; 8: 786–802.Google Scholar
5. Diaz, MN, Frei, B, Vita, JA, Keaney, JF Jr. Antioxidants and atherosclerotic heart disease. N Engl J Med 1997; 337: 408–416.Google Scholar
6. Jha, P, Flather, M, Lonn, E, Farkouh, M, Yusuf, S. The antioxidant vitamins and cardiovascular disease. Ann Intern Med 1995; 123: 860–872.Google Scholar
7. Meydani, SN, Meydani, M, Blumberg, JB, et al. Vitamin E supplementation and in vivo immune response in healthy elderly subjects. JAMA 1997; 277: 1380–1386.Google Scholar