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Dementia: Assessment, management and support for people living with dementia and their carers. London: National Institute for Health and Care Excellence (NICE); 2018 Jun. (NICE Guideline, No. 97.)
Dementia: Assessment, management and support for people living with dementia and their carers.
Show detailsG.1. Dementia diagnosis
G.1.1. Dementia diagnosis
- What are the most effective methods of primary assessment to decide whether a person with suspected dementia should be referred to a dementia service?
- What are the most effective methods of diagnosing dementia and dementia subtypes in specialist dementia diagnostic services?
Please see appendix P
G.1.2. Distinguishing dementia from delirium or delirium with dementia
- What are the most effective methods of differentiating dementia or dementia with delirium from delirium alone?
G.1.2.1. Confusion assessment method (CAM)
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G.1.2.2. Delirium Index (DI)
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G.1.2.3. Short Portable Mental State Questionnaire (SPMSQ)
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G.1.2.4. Delirium Rating Scale Revised 98 (DRS-R98)
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G.1.2.5. Cognitive Test for Delirium (CTD)
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G.1.2.6. Observational Scale of Level of Arousal (OSLA) and OSLA combined with the Attention Test
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G.1.3. Case finding for people at high risk of dementia
- What are the most effective methods of case finding for people at high risk of dementia?
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G.2. Involving people with dementia in decision about care
G.2.1. Barriers and facilitators to involvement in decision making for people living with dementia
- What barriers and facilitators have an impact on involving people living with dementia in decisions about their present and future care?
- What barriers and facilitators have an impact on how people living with dementia can make use of advance planning?
G.2.1.1. Barriers to decision making
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G.2.1.2. Facilitators for decision making
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G.2.1.3. Issues identified in Huntington’s disease
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G.3. Care planning, review and co-ordination
G.3.1. Health and social care co-ordination
Review questions
- What are the most effective methods of care planning, focussing upon improving outcomes for people with dementia and their carers?
- How should health and social care be co-ordinated for people living with dementia?
G.3.1.1. CERQual tables
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G.3.1.2. GRADE tables
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G.3.2. Post diagnosis review for people living with dementia
- How should people living with dementia be reviewed post diagnosis?
G.3.2.1. Managed health services in partnership with Alzheimer’s associations services versus usual managed care services only
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G.3.2.2. Multidisciplinary case conferences versus usual care
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G.3.2.3. Network multidisciplinary care versus usual care
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G.3.2.4. Memory clinic follow up versus GP follow up
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G.3.2.5. Specialist care in memory clinic versus usual care in memory clinic
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G.4. Inpatient care
G.4.1. Caring for people living with dementia who are admitted to hospital
- How should people living with dementia be cared for when admitted to hospital?
G.4.1.1. Nurse-led mental health liaison service versus usual care
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G.4.1.2. Family-centred function focused care versus usual care
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G.4.1.3. Proactive case finding with palliative care service versus usual care
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G.4.1.4. Specialist medical and mental health unit versus usual care
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G.4.1.5. Follow-up individualised care plan versus usual care
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G.5. Care setting transitions
G.5.1. Managing the transition between different settings for people living with dementia
- What are the most effective ways of managing the transition between different settings (home, care home, hospital, and respite) for people living with dementia?
G.5.1.1. Interventions for people living with dementia
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G.5.1.2. Interventions for carers
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G.5.1.3. Residential Care Transition Module
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G.5.1.4. FITT-NH (Family Intervention: Telephone Tracking-Nursing Home)
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G.6. Modifying risk factors for dementia progression
G.6.1. Risk factors for dementia progression
- What effect does modifying risk factors have on slowing the progression of dementia?
G.6.1.1. Antidiabetic drugs versus placebo
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G.6.1.2. NSAIDs versus placebo
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G.6.1.3. Statins versus placebo
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G.6.1.4. Antihypertensive drugs
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G.6.1.5. Angiotensin II receptor antagonist versus calcium-channel blocker
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G.6.1.6. Brain-penetrating angiotensin converting enzyme (ACE) inhibitor versus calcium-channel blocker
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G.6.1.7. Non-brain-penetrating ACE inhibitor versus calcium-channel blocker
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G.7. Cholinesterase inhibitors and memantine for dementia
G.7.1. Cholinesterase inhibitors and memantine for people living with Alzheimer’s disease
- Who should start and review the following pharmacological interventions: (donepezil, galantamine, rivastigmine, memantine) for people with Alzheimer’s disease and how should a review be carried out?
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G.7.2. Cholinesterase inhibitors and memantine in Alzheimer’s disease
- How effective is the co-prescription of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s disease?
- When should treatment with donepezil, galantamine, rivastigmine, memantine be withdrawn for people with Alzheimer’s disease?
G.7.2.1. Any cholinesterase inhibitor plus memantine versus any cholinesterase inhibitor plus placebo
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G.7.2.2. Any cholinesterase inhibitor plus memantine versus cholinesterase inhibitor monotherapy
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G.7.2.3. Any cholinesterase inhibitor plus memantine versus memantine plus placebo
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G.7.2.4. Cholinesterase inhibitor withdrawal
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G.7.2.5. Cholinesterase inhibitor switch to memantine
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G.7.3. Pharmacological management of Parkinson’s disease dementia
- What is the comparative effectiveness of donepezil, galantamine, memantine and rivastigmine for cognitive enhancement in dementia associated with Parkinson’s disease?
G.7.3.1. Parkinson’s disease dementia – cholinesterase inhibitors
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G.7.3.2. Parkinsons disease dementia – memantine
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G.7.3.3. Dementia with Lewy bodies – cholinesterase inhibitors
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G.7.3.4. Dementia with Lewy bodies – memantine
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G.7.3.5. Mixed population (PDD or DLB) – cholinesterase inhibitors
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G.7.3.6. Mixed population (PDD or DLB) – memantine
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G.7.4. Cholinesterase inhibitors and memantine for types of dementia other than typical Alzheimer’s disease
- How effective are cholinesterase inhibitors and memantine for types of dementia other than typical Alzheimer’s disease?
G.7.4.1. Vascular dementia
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G.7.4.2. Behavioural variant frontotemporal dementia
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G.7.4.3. Semantic variant frontotemporal dementia
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G.7.4.4. Cognitive impairment in people with multiple sclerosis
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G.7.4.5. Huntington’s disease
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G.8. Drugs that may worsen cognitive decline
G.8.1. Drugs that may cause cognitive decline
- What drugs that may worsen cognitive decline are commonly prescribed in people diagnosed with dementia?
- What are the most effective tools to identify whether drugs may be the cause of cognitive decline in someone suspected of having dementia?
No GRADE or CERQual tables were produced for this review question
G.9. Non-pharmacological interventions for dementia
G.9.1. Non-pharmacological interventions for people living with dementia
- What are the most effective non-pharmacological interventions for supporting cognitive functioning in people living with dementia?
- What are the most effective non-pharmacological interventions for supporting functional ability in people living with dementia?
- What are the most effective non-pharmacological interventions to support wellbeing in people living with dementia?
- What are the most effective methods of supporting people living with dementia to reduce harm and stay independent?
G.9.1.1. Cognitive stimulation therapy
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G.9.1.2. Cognitive training
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G.9.1.3. Cognitive rehabilitation
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G.9.1.4. Self-management groups
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G.9.1.5. Reminiscence therapy
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G.9.1.6. Occupational therapy
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G.9.1.7. Psychotherapy
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G.9.1.8. Exercise
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G.9.1.9. Nutrition
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G.9.1.10. Music therapy
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G.9.1.11. Aromatherapy
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G.9.1.12. Light therapy in people with dementia
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G.9.1.13. Non-invasive brain stimulation
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G.9.1.14. Non-invasive brain stimulation in people with mild vascular dementia (post-intervention)
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G.9.1.15. Acupuncture
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G.9.1.16. Assisted animal therapy
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G.9.1.17. Robotic pet therapy
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G.9.1.18. Adapted mindfulness program
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G.9.1.19. Home safety toolkit
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G.9.2. Pre, peri and post-diagnostic counselling and support for people living with dementia and their families
- How effective are pre, peri & post-diagnostic counselling and support on outcomes for people living with dementia and their families?
G.9.2.1. Psychosocial interventions (outcomes in people with dementia)
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G.9.2.2. Psychosocial interventions (outcomes in caregivers)
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G.9.2.3. Self-management interventions (outcomes in people with dementia)
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G.9.2.4. Self-management interventions (outcomes in spouses)
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G.10. Managing non-cognitive symptoms
G.10.1. Interventions for treating illness emergent non-cognitive symptoms in people living with dementia
- What are the most effective pharmacological interventions for managing illness emergent non-cognitive symptoms, such as psychosis, depression, behavioural changes in people living with dementia?
- What are the most effective non-pharmacological interventions for managing illness emergent non-cognitive symptoms, such as psychosis, depression, behavioural changes in people living with dementia?
G.10.1.1. Anxiety and depression
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G.10.1.2. Antidepressants for other non-cognitive symptoms
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G.10.1.3. Antipsychotics
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G.10.1.4. Memantine vs placebo (mild Alzheimer’s disease)
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G.10.1.5. Sleep problems
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G.10.1.6. Pharmacological management of agitation, aggression and apathy
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G.11. Supporting informal carers
G.11.1. Supporting informal carers of people living with dementia
- How effective are carers’ assessments in identifying the needs of informal carers of people living with dementia?
- What interventions/services are most effective for supporting the wellbeing of informal carers of people living with dementia?
G.11.1.1. Psychoeducational interventions
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G.11.1.2. Skills training
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G.11.1.3. Psychoeducation and skills training
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G.11.1.4. Supportive interventions
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G.11.1.5. Respite care
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G.11.1.6. Psychotherapy
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G.11.1.7. Case management
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G.11.1.8. Multicomponent interventions
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G.11.1.9. Exercise
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G.11.1.10. Memory clinic
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G.11.1.11. Meditation/mindfulness
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G.11.1.12. Cranial electrotherapy stimulation
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G.11.1.13. Psychotherapy versus psychoeducational interventions
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G.11.1.14. CBT versus ACT (acceptance and commitment therapy)
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G.11.1.15. Spiritual care
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G.11.1.16. Meta-regression
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G.12. Staff training
G.12.1. Staff training
- What effect does training for staff working with people living with dementia have upon the experiences of people living with dementia in their care?
G.12.1.1. Residential care staff training: flexible education
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G.12.1.2. Residential care staff training: activity provision
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G.12.1.3. Residential care staff training: multi-sensory stimulation (snoezelen)
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G.12.1.4. Residential care staff training: behaviour management with motivational system
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G.12.1.5. Residential care staff training: feeding skills
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G.12.1.6. Residential care staff training: dementia care mapping
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G.12.1.7. Residential care staff training: person-centred care
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G.12.1.8. Residential care staff training: awareness and communication
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G.12.1.9. Residential care staff training: challenging behaviours
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G.12.1.10. Residential care staff training: challenging behaviours with peer support
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G.12.1.11. Residential care staff training: communication skills
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G.12.1.12. Residential care staff training: emotion-oriented care
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G.12.1.13. Residential care staff training: reducing antipsychotic drug use
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G.12.1.14. Residential care staff training: towel bathing
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G.12.1.15. Residential care staff training: person-centred showering
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G.12.1.16. Residential care staff training: apathy management
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G.12.1.17. Residential care staff training: sensitivity to non-verbal emotion signals
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G.12.1.18. Residential care staff and nurse training: effective communication, empathy development and conflict resolution
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G.12.1.19. Residential care staff and nurse training: restraint use reduction
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G.12.1.20. Residential care nurse training: managing depression nursing guideline
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G.12.1.21. Residential care nurse training: restraint reduction
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G.12.1.22. Residential care nurse training: dementia care mapping
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G.12.1.23. Occupational therapist training: interdisciplinary training
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G.12.1.24. GP training: flexible education
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G.12.1.25. Pooled analysis: person-centred care versus control
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G.13. Needs of younger people living with dementia
G.13.1. The specific needs of younger people living with dementia
Review question
- What are the specific needs of younger people living with dementia?
G.13.1.1. CERQual tables
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G.14. Assessing and managing comorbidities
G.14.1. Assessing and treating intercurrent illness in people living with dementia
- Are there effective methods for assessing intercurrent illness in people living with dementia that are different from those already in use for people who do not have dementia?
- Are there effective methods for treating intercurrent illness in people living with dementia that are different from those already in use for people who do not have dementia?
G.14.1.1. Assessing intercurrent illness
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G.14.1.2. Management of intercurrent illness
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G.14.2. Management strategies for people living with dementia and co-existing physical long term conditions
- What are the optimal management strategies (including treatments) for people living with dementia with co-existing physical long term conditions?
G.14.2.1. Hypertension
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G.14.2.2. Cardiovascular disease
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G.14.2.3. Diabetes
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G.14.2.4. Incontinence
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G.14.2.5. Age-related hearing impairment
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G.15. Managing mental health conditions alongside dementia
- RQ20: What are the optimal management strategies (including treatments) for people with dementia and an enduring mental health condition?
No GRADE or CERQual tables were produced for this review question
G.16. Palliative care
G.16.1. Palliative care
- What models of palliative care are effective for people with dementia
G.16.1.1. Qualitative evidence
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G.16.1.2. Quantitative evidence
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- Dementia diagnosis
- Involving people with dementia in decision about care
- Care planning, review and co-ordination
- Inpatient care
- Care setting transitions
- Modifying risk factors for dementia progression
- Cholinesterase inhibitors and memantine for dementia
- Drugs that may worsen cognitive decline
- Non-pharmacological interventions for dementia
- Managing non-cognitive symptoms
- Supporting informal carers
- Staff training
- Needs of younger people living with dementia
- Assessing and managing comorbidities
- Managing mental health conditions alongside dementia
- Palliative care
- GRADE and CERQual tables - DementiaGRADE and CERQual tables - Dementia
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