EBP Compendium: Summary of Clinical Practice Guideline
Scottish Intercollegiate Guidelines Network
Management of Patients with Dementia
Scottish Intercollegiate Guidelines Network.
Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN), SIGN Publication No. 86, 57 pages.
AGREE Rating: Highly Recommended
This guideline provides recommendations for the management of individuals with dementia. The target audience of this guideline includes physicians, healthcare professionals, patients and carers. Of particular interest to speech-language pathologists is the section pertaining to non-pharmacological interventions for the behavioral symptoms of dementia. Levels of evidence are provided and defined as follows: Grade A recommendations are based on evidence from systematic reviews and meta-analyses of randomized controlled trials that are directly relevant to the population. Grade B recommendations include high quality case control or cohort studies or high quality systematic reviews of those studies that are directly applicable to the population, or recommendations extrapolated from Grade A evidence. Grade C recommendations include well conducted case control or cohort studies or recommendations extrapolated from Grade B evidence. Grade D recommendations are based on evidence from non-analytic studies or expert opinion or recommendations extrapolated from Grade C evidence. Good Practice Points are recommendations based on the clinical experience of the guideline development group.
- Assessment Instruments
- Mini-Mental Status Examination - The Mini-Mental Status Examination (MMSE) can be used to assess individuals with cognitive impairment. The MMSE should be used to diagnosis dementia in individuals with suspected cognitive impairments (Grade B Evidence).
- Compensatory Treatments
- Memory Books - The use of memory books "lacked evidence of clinical effectiveness" (p. 12).
- Restorative Treatments
- Cognitive Stimulation - "Cognitive stimulation should be offered to individuals with dementia (Grade B Evidence)" (p. 8)
- Reality Orientation - "Reality orientation therapy should be used by a skilled practitioner on an individualized basis, with people who are disoriented in time, place or person" (Grade D Evidence) (p. 11).
- Reminiscence Therapy - Reminiscence therapy "lacked sufficient evidence of clinical effectiveness" (p. 12).
- Simulated-Presence Therapy -"Simulated presence therapy is not effective for reduction of agitation in nursing home residents with severe dementia" (p. 12).
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Added to Compendium: November 2011