DESK REVIEWS | 04.06.01. Are there standards, guidelines or protocols for dementia?
DESK REVIEW | 04.06.01. Are there standards, guidelines or protocols for dementia?
Yes. There is a “Clinical Protocol of Therapeutic Guidelines” (Protocolo Clínico de Diretrizes Terapêuticas – PCDT) about Alzheimer’s Disease”. It guides health professionals and the population on the diagnosis and treatment of Alzheimer’s Disease (Brazilian Ministry of Health, 2017c). There is also a “Technical-Scientific Opinion” (Parecer Técnico-Científico) about the prevention of Alzheimer’s Disease (Valle, 2013), the “recommendations for diagnosing Alzheimer’s disease in Brazil” (Nitrini et al., 2005), and “recommendations in Alzheimer” (Brucki & Schultz, 2011).
Brazilian Ministry of Health. (2017c). PCDT Alzheimer. Brazilian Ministry of Health.
Brucki, S. M. D., & Schultz, R. (2011). Manual de recomendações da ABN em Alzheimer-2011. 5. https://neurologiahu.ufsc.br/files/2012/08/Manual-de-recomendações-da-ABN-em-Alzheimer-2011.pdf
Nitrini, R., Caramelli, P., Damasceno, B. P., Brucki, S. M. D., & Anghinah, R. (2005). Diagnóstico de Doença de Alzheimer no Brasil. Avaliação cognitiva e funcional. Arq Neuropsiquiatr, 8.
Valle, E. A. (2013). Parecer Técnico-Científico: Prevenção da demência.
The Indian Psychiatric Society (IPS) published Clinical Practice Guidelines (CPGs) for the management of dementia in 2007 and revised this in 2018 (Grover and Avasthi, 2017). In addition, the Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) and the International Classification of Diseases-11th revision (ICD-11) guidelines for dementia are followed by healthcare professionals in India.
Grover, S., and Avasthi, A. (2017). Indian Psychiatric Society Survey on Clinical Practice Guidelines. Indian Journal of Psychiatry, 59(5), 10. https://doi.org/10.4103/0019-5545.196971
There is a clinical guide-book on dementia, which has been published by the Association of Neurologists in Indonesia (Perhimpunan Dokter Spesialis Saraf Indonesia (PERDOSSI)) in 2015. The book contains guidelines, protocols, and recommendations for all types of healthcare facilities (PERDOSSI, 2015).
PERDOSSI. (2015). Panduan Praktik Klinik: Diagnosis dan Penatalaksanaan Demensia. PERDOSSI.
There are currently no national or sub-national online accessible documents on standards, guidelines or protocols specific to dementia in Kenya. The national government has published clinical guidelines for management and referral of the following mental disorders: psychosis, alcohol withdrawal syndrome, substance use, anxiety, PTSD, psychosexual disorders, depression, bipolar disorder, schizophrenia, sleep disorders, and suicides (Crouch, 2009; Management & Guidelines, 2009). None of these documents mention dementia explicitly at primary care or hospital level.
Crouch, M. (2009). Clinical Management and Referral Guidelines Volume II: Clinical Guidelines for Management and Referral of Common Conditions at Levels 2–3: Primary Care. Ministry of Medical Services and Ministry of Public Health and Sanitation. Nairobi, Kenya. 282–289. http://publications.universalhealth2030.org/uploads/clinical_guidelines_vol_ii_final.pdf
Management & Guidelines (2009). Levels 4–6 – Hospitals i.
Three clinical practice guidelines have been developed in Mexico in relation to dementia and cognitive impairment:
- Diagnosis and Treatment of Alzheimer’s Disease. Evidence and Recommendations Guide: Clinical Practice Guide. Updated in 2017 (CENETEC, 2017).
- Clinical Practice Guide Diagnosis and treatment of vascular dementia in adults in the three levels of care, updated in 2017 (Secretaría de Salud, 2017).
- Guide to Clinical Practice, Diagnosis and Treatment of Cognitive Impairment in the Elderly in the First Level of Care, Mexico, updated in 2012 (Secretaría de Salud, 2012).
CENETEC. (2017). Diagnóstico y Tratamiento de la Enfermedad de Alzheimer. Guía de Evidencias y Recomendaciones: Guía de Práctica Clínica. Guia de Practica Clinica. http://www.cenetec-difusion.com/CMGPC/IMSS-393-10/RR.pdf
Secretaría de Salud. (2012). Guía de Práctica y Tratamiento del Deterioro Cognostivo en el Adulto Mayor en el Primer Nivel de Atención. In CENETEC (Vol. 1).
Secretaría de Salud. (2017). Guía de Práctica Clínica Diagnóstico y Tratamiento de demencia vascular en el adulto en los tres niveles de atención.
The South African Society of Psychiatrists (SASOP) has developed guidelines for treatment of a range of psychiatric disorders and has dedicated a chapter on Dementia. This document refers to the country’s private healthcare settings and provides guidelines for (a) the diagnosis, clinical characteristics, and course of the disease; (b) the assessment and differential diagnosis; as well as (c) treatment goals with clinical guidelines for the pharmacological and non-pharmacological treatment of dementia (Emsley et al., 2013, p.141-152). Many who rely on public healthcare do not have access to many of the pharmacological treatments recommended by these guidelines (Emsley et al., 2013) as the public sector is characterised by constrained and limited resources and lack of specialist treatments and approaches particular to dementia.
In the public sector, there are also Standard Treatment Guidelines available from the National Department of Health that provide guidelines for the treatment of dementia and focuses primarily on pharmacological/medicine treatment (National Department of Health, 2020).
South Africa has a National Strategic plan for nurse education, training and practice (DOH, 2016), and approved competencies for nursing to provide care throughout the lifespan. However, these are not dementia-specific and support generic models for care at hospitals and other facilities.
DOH. (2016). The National Strategic Plan for Nurse Education, Training and Practice.
Emsley, R., & Seedat, S. (2013). The South African Society of Psychiatrists (SASOP) treatment guidelines for psychiatric disorders. South African Journal of Psychiatry, 19(3), 127–196. https://doi.org/10.4102/sajpsychiatry.v19i3.942
National Department of Health. (2020). Primary healthcare Standard Treatment Guidelines And Essential Medicines List (7th ed). Available from: https://www.knowledgehub.org.za/elibrary/primary-healthcare-standard-treatment-guidelines-and-essential-medicines-list-7th-edition