American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

Brenda Strafford Foundation; Canadian Institutes of Health Research (CIHR); Ontario Mental Health Foundation; Saskatchewan Health Research Foundation; Alzheimer Society of Saskatchewan; University of Saskatchewan
Management of Mild to Moderate Alzheimer's Disease and Dementia

Hogan, D. B., Bailey, P., et al. (2007).
Alzheimer's & Dementia, 3(4), 355-384.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations for the management of individuals with mild to moderate stages of dementia and Alzheimer’s disease. While the guideline primarily targets primary care physicians, the guideline includes recommendations on non-pharmalogical cognitive treatments. Levels of evidence and grade of recommendation (i.e., strength of recommendations) are provided and are defined as follows: Level I is evidence from at least one properly randomized controlled trial. Level II is evidence from well-designed controlled trials without randomization. Level III is evidence from well-designed cohort or case-control analytic studies. Level IV is evidence from comparisons between times or places with or without the intervention. Level V evidence is based on opinions of experts. Grade A indicates that good evidence supports the maneuver. Grade B indicates that fair evidence supports the maneuver. Grade C indicates that the published evidence is either conflicting or insufficient and, as such, a recommendation for or against is not provided. Grade D indicates that fair evidence against the maneuver exists. Grade E indicates that good evidence against the maneuver exists.

Recommendations:

  • Treatment
    • Cognition
      • Compensatory Treatments
        • General Findings - "There is insufficient research evidence to come to any firm conclusions about the effectiveness of cognitive training/cognitive rehabilitation in improving and/or maintaining cognitive and/or functional performance in persons with mild or moderate dementia" (Grade C, Level 1 Evidence) (p. 559). Further research is warranted for individuals with mild to moderate dementia.
        • Environmental Modification - "Although there is some indication of a beneficial impact on [instrumental activities of daily living] IADL and [activities of daily living] ADL, there is insufficient evidence to make firm conclusions about the effectiveness of environmental interventions in promoting functional performance in persons with mild or moderate dementia" (Grade C, Level 1 Evidence) (p. 559).
      • Restorative Treatments
        • General Findings - "There is insufficient research evidence to come to any firm conclusions about the effectiveness of cognitive training/cognitive rehabilitation in improving and/or maintaining cognitive and/or functional performance in persons with mild or moderate dementia" (Grade C, Level 1 Evidence) (p. 559). Further research is warranted for individuals with mild to moderate dementia.

Keywords: Alzheimer's Disease, Dementia, Cognition

Access the Guideline

Added to Compendium: November 2011

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