It is not clear how many studies were included or the total number of participants.
1. Identification of people with dementia.
Memory complaints by patients correlate with depression. The 'Short Mental Questionnaire' is a caregiver-administered screening tool, sensitive to mild dementia. A case-control study reported that using a prevalence of Alzheimer's of 10%, the positive predictive value was 63.5%, and the negative predictive value was 100%. General Practitioners' clinical judgement alone compares unfavourably with the use of a formal cognitive testing in the diagnosis of dementia (n= 3 studies).
The Mini Mental State Examination can be abbreviated for use in Primary Care with only a small reduction in specificity (n= 1 study).
The Abbreviated Mental Test Score has proved statistically significant for discriminating between different types of dementia (n=1 study).
2. Physical screening of people with dementia in primary care.
In a small proportion of people with dementia there is an underlying pathology which when treated results in improvement in cognitive function.
3. Depression and behavioural disorders in people with dementia.
For depression, there were few drug treatment trials that were of acceptable methodological quality. There is a placebo response rate of 67% of individuals treated with neuroleptic agents for the control of behavioural disorders in dementia. There is no difference between neuroleptic agents used and no identifiable differences between responders and non-responders (n=2 RCTs).
4. Non-drug therapies (structured programmes to encourage independence).
Skills training for people with dementia in residential care may lead to an improvement in personal care skill (p=0.04)(n=1 study).
Music therapy for people with dementia in residential care leads to an improvement in personal recollection, social disposition, enjoyment and interaction during treatment (p<0.01) (n=1 study).
Activities and education for people with dementia in residential care leads to a decrease in behavioural disorder and an increase in the activity level of the sufferer(n=1 study).
5. Anti-dementia therapy (aspirin in vascular dementia, hydergine, vasodilators, tacrine, deonepezil hydrochloride).
Aspirin.
Aspirin is of benefit in preventing vascular events or vascular deaths in patients with a history of prior transient ischaemic attack or stroke (risk reduction 4.3% (95% CI: 2.8%, 5.8%) (n=1 review with 19 trials).
Hydergine.
Both reviews and studies demonstrate small improvements of variable sustainability. Responders to hydergine cannot be predicted in advance.
Vasodilators.
There is no consistent evidence of clinical benefit from vasodilators in dementia (review of 102 studies).
Tacrine.
Overall pooled estimates of effect for the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADA-cog), the Mini Mental State Exam and activities of daily living scales were calculated (n=12 RCTs). For the ADA-cog (n=4 studies), the pooled effect size was -0.34 (95% CI: -0.47, -0.22); for the Mini Mental State Exam (n=8 studies) pooled effect size was 0.0944 (95% CI: 0.0045, 0.1844), for activities of daily living scales (5 trials) pooled effect size was -0.0111 (95% CI: -0.2022, 0.1801). Tacrine has important side effects including elevated tranaminases, nausea and vomiting, diarrhoea, abdominal pain, dyspepsia and rash. Patients randomised to tacrine treatment were more likely than those on placebo to cease treatment (OR 2.94, 95% CI: 2.14, 4.05).
Velnacrine (n=2 trials).
Appearing similar in efficacy to tacrine, velnacrine also leads to substantial hepatotoxicity, and appears on current evidence to have no advantage over tacrine.
Donepezil Hydrochloride.
For the ADA-cog (n=5 studies), the pooled effect size was -0.4907 (95% CI: -0.6014, -0.3801); for the Mini Mental State Exam (n=5 studies) pooled effect size was 0.37 (95% CI: 0.26, 0.48), for quality of life scales (n=5 studies) pooled effect size was 0.0226 (95% CI: -0.1562, 0.2015). Overall there was no relationship between treatment with donepezil and withdrawal from treatment in trials.
6. Care of the carers (n=7 RCTs).
Neither care support groups or information to carers affect outcomes related to carers.
Respite services offer satisfaction and relief to carers and may delay institutionalisation. It does not reduce the overall well- being of the carer.
Intensive community support with a counselling package for a person with dementia and their carer appears to increase the likelihood of staying at home.