The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia

Objective: To develop evidence based consensus statements on which to build clinical practice guidelines for primary care physicians toward the recogn ition, assessment and management of dementing disorders and to disseminate and evaluate the impact of these statements and guidelines built on these s tatements. Options: Structured approach to assessment, including recommended laborator y tests, choices for neuroimaging and referral, management of complications (especially behavioural problems and depression) and use of cognitive enha ncing agents. Potential outcomes: Consistent and improved clinical care of persons with d ementia; cost containment by more selective use of laboratory investigation s, neuroimaging and referrals; and appropriate use of cognitive enhancing a gents. Evidence: Authors of each background paper were entrusted to perform a lite rature search, discover additional relevant material, including references cited in retrieved articles, consult with other experts in the field and th en synthesize information. Standard rules of evidence were applied. Based o n this evidence, consensus statements were developed by a group of experts, guided by a steering committee of 8 individuals, from the areas of Neurolo gy, Geriatric Medicine, Psychiatry, Family Medicine, Preventive Health Care and Health Care Systems. Values: Recommendations have been developed with particular attention to th e context of primary care, and are intended to support family physicians in their ongoing assessment and care of patients with dementia. Benefits, harm and costs: Potential for improved clinical care of people wi th dementia. A dissemination and evaluation strategy will attempt to measur e the impact of the recommendations. Recommendations: Forty-eight recommendations are offered that address the f ollowing aspects of dementia care: early recognition; importance of careful history and examination in making a positive diagnosis; essential laborato ry tests; rules for neuroimaging and referral; disclosure of diagnosis; imp ortance of monitoring and providing support to caregivers; cultural aspects ; detection and treatment of depression; observation and management of beha vioural disturbances; detection and reporting of unsafe motor vehicle drivi ng; genetic factors and opportunities for preventing dementia; pharmacologi cal treatment with particular emphasis on cognitive enhancing agents. Validation: Four other sets of consensus statement or guidelines have been published recently. These recommendations are generally congruent with our own consensus statements. The consensus statements have been endorsed by re levant bodies in Canada. Sponsors: Funding was provided by equal contributions from 7 pharmaceutical companies and by a grant from the Consortium of Canadian Centres for Clini cal Cognitive Research. Contributions were received from 2 Canadian univers ities (McGill, McMaster). Several societies supported delegates attending t he conference.