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Clinical practice with anti-dementia drugs: a revised (third) consensus statement from the British Association for Psychopharmacology

Clinical practice with anti-dementia drugs: a revised (third) consensus statement from the British Association for Psychopharmacology
Clinical practice with anti-dementia drugs: a revised (third) consensus statement from the British Association for Psychopharmacology
The British Association for Psychopharmacology coordinated a meeting of experts to review and revise its previous 2011 guidelines for clinical practice with anti-dementia drugs. As before, levels of evidence were rated using accepted standards which were then translated into grades of recommendation A–D, with A having the strongest evidence base (from randomised controlled trials) and D the weakest (case studies or expert opinion).

Current clinical diagnostic criteria for dementia have sufficient accuracy to be applied in clinical practice (B) and both structural (computed tomography and magnetic resonance imaging) and functional (positron emission tomography and single photon emission computerised tomography) brain imaging can improve diagnostic accuracy in particular situations (B). Cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) are effective for cognition in mild to moderate Alzheimer’s disease (A), memantine for moderate to severe Alzheimer’s disease (A) and combination therapy (cholinesterase inhibitors and memantine) may be beneficial (B). Drugs should not be stopped just because dementia severity increases (A). Until further evidence is available other drugs, including statins, anti-inflammatory drugs, vitamin E, nutritional supplements and Ginkgo biloba, cannot be recommended either for the treatment or prevention of Alzheimer’s disease (A). Neither cholinesterase inhibitors nor memantine are effective in those with mild cognitive impairment (A). Cholinesterase inhibitors are not effective in frontotemporal dementia and may cause agitation (A), though selective serotonin reuptake inhibitors may help behavioural (but not cognitive) features (B). Cholinesterase inhibitors should be used for the treatment of people with Lewy body dementias (both Parkinson’s disease dementia and dementia with Lewy bodies), and memantine may be helpful (A). No drugs are clearly effective in vascular dementia, though cholinesterase inhibitors are beneficial in mixed dementia (B). Early evidence suggests multifactorial interventions may have potential to prevent or delay the onset of dementia (B). Though the consensus statement focuses on medication, psychological interventions can be effective in addition to pharmacotherapy, both for cognitive and non-cognitive symptoms. Many novel pharmacological approaches involving strategies to reduce amyloid and/or tau deposition in those with or at high risk of Alzheimer’s disease are in progress. Though results of pivotal studies in early (prodromal/mild) Alzheimer’s disease are awaited, results to date in more established (mild to moderate) Alzheimer’s disease have been equivocal and no disease modifying agents are either licensed or can be currently recommended for clinical use.
0269-8811
147
O'Brien, John
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Holmes, Clive
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Jones, Matthew
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Jones, Roy
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Livingstone, Gill
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McKeith, Ian
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Mittler, Peter
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Passmore, Peter
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Ritchie, Craig
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Robinson, Louise
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Sampson, Elizabeth
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Taylor, John-Paul
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Thomas, Alan
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Burns, Alistair
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O'Brien, John
a399256b-4108-47f0-ba59-38273c220db4
Holmes, Clive
ada5abf3-8459-4cf7-be40-3f4e9391cc96
Jones, Matthew
71967fef-01a3-46fd-b8aa-14cbabb16d13
Jones, Roy
9ff742d5-825d-4207-ba3b-01c6112701bc
Livingstone, Gill
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McKeith, Ian
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Mittler, Peter
3b52ef0b-3ed3-41d4-9749-50296baf2e4b
Passmore, Peter
789a148f-112d-433d-810f-a11d05077b3b
Ritchie, Craig
28b475a6-0138-48e0-8391-97c94312fd35
Robinson, Louise
488aea33-4475-4b1f-83f8-018bfcb56a1f
Sampson, Elizabeth
047ec35b-a5cc-4a7b-b523-c9e3b463d3d0
Taylor, John-Paul
c34d9d04-e23c-49c7-a36c-50138a115bd6
Thomas, Alan
4b463fcf-1e60-468e-b5a0-a33b89a7540f
Burns, Alistair
8425afda-c2e0-45ad-b7ce-a3757b8ed80d

O'Brien, John, Holmes, Clive, Jones, Matthew, Jones, Roy, Livingstone, Gill, McKeith, Ian, Mittler, Peter, Passmore, Peter, Ritchie, Craig, Robinson, Louise, Sampson, Elizabeth, Taylor, John-Paul, Thomas, Alan and Burns, Alistair (2017) Clinical practice with anti-dementia drugs: a revised (third) consensus statement from the British Association for Psychopharmacology. Journal of Psychopharmacology, 31 (2), 147. (doi:10.1177/0269881116680924).

Record type: Article

Abstract

The British Association for Psychopharmacology coordinated a meeting of experts to review and revise its previous 2011 guidelines for clinical practice with anti-dementia drugs. As before, levels of evidence were rated using accepted standards which were then translated into grades of recommendation A–D, with A having the strongest evidence base (from randomised controlled trials) and D the weakest (case studies or expert opinion).

Current clinical diagnostic criteria for dementia have sufficient accuracy to be applied in clinical practice (B) and both structural (computed tomography and magnetic resonance imaging) and functional (positron emission tomography and single photon emission computerised tomography) brain imaging can improve diagnostic accuracy in particular situations (B). Cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) are effective for cognition in mild to moderate Alzheimer’s disease (A), memantine for moderate to severe Alzheimer’s disease (A) and combination therapy (cholinesterase inhibitors and memantine) may be beneficial (B). Drugs should not be stopped just because dementia severity increases (A). Until further evidence is available other drugs, including statins, anti-inflammatory drugs, vitamin E, nutritional supplements and Ginkgo biloba, cannot be recommended either for the treatment or prevention of Alzheimer’s disease (A). Neither cholinesterase inhibitors nor memantine are effective in those with mild cognitive impairment (A). Cholinesterase inhibitors are not effective in frontotemporal dementia and may cause agitation (A), though selective serotonin reuptake inhibitors may help behavioural (but not cognitive) features (B). Cholinesterase inhibitors should be used for the treatment of people with Lewy body dementias (both Parkinson’s disease dementia and dementia with Lewy bodies), and memantine may be helpful (A). No drugs are clearly effective in vascular dementia, though cholinesterase inhibitors are beneficial in mixed dementia (B). Early evidence suggests multifactorial interventions may have potential to prevent or delay the onset of dementia (B). Though the consensus statement focuses on medication, psychological interventions can be effective in addition to pharmacotherapy, both for cognitive and non-cognitive symptoms. Many novel pharmacological approaches involving strategies to reduce amyloid and/or tau deposition in those with or at high risk of Alzheimer’s disease are in progress. Though results of pivotal studies in early (prodromal/mild) Alzheimer’s disease are awaited, results to date in more established (mild to moderate) Alzheimer’s disease have been equivocal and no disease modifying agents are either licensed or can be currently recommended for clinical use.

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Accepted/In Press date: 19 January 2017
e-pub ahead of print date: 20 January 2017
Published date: 1 February 2017
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 408021
URI: https://eprints.soton.ac.uk/id/eprint/408021
ISSN: 0269-8811
PURE UUID: de25371e-03b2-4219-a171-c3a249298a4f
ORCID for Clive Holmes: ORCID iD orcid.org/0000-0003-1999-6912

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Date deposited: 09 May 2017 01:03
Last modified: 03 Dec 2019 01:55

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Contributors

Author: John O'Brien
Author: Clive Holmes ORCID iD
Author: Matthew Jones
Author: Roy Jones
Author: Gill Livingstone
Author: Ian McKeith
Author: Peter Mittler
Author: Peter Passmore
Author: Craig Ritchie
Author: Louise Robinson
Author: Elizabeth Sampson
Author: John-Paul Taylor
Author: Alan Thomas
Author: Alistair Burns

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