Clinical Practice Guideline for Dementia 2017

Table of Contents

Publication of the English Version of “Clinical Practice Guideline for Dementia 2017”

Preface: Clinical Practice Guideline for Dementia 2017, Japanese version

List of Authors

PDF

Chapter 1 Overview of Dementia: Epidemiology, Definitions, TermsPDF

CQ 1-1 What are the diagnostic criteria for dementia?

CQ 1-2 What other terms are related to dementia?

CQ 1-3 What are the causes of dementia and how are they classified?

CQ 1-4 What pathological conditions should be differentiated from dementia?

CQ 1-5 What is the prevalence of dementia in Japan?

CQ 1-6 Are there changes in prevalence depending on subtype of dementia?

CQ 1-7 Is the disease duration of dementia getting longer?

CQ 1-8 What is the pathological background of dementia?

Chapter 2 Syndrome, Rating Scales, Tests, DiagnosisPDF

Preface

CQ 2-1 What kinds of cognitive function impairment are found in dementia?

CQ 2-2 What are the behavioral and psychological symptoms of dementia (BPSD)?

CQ 2-3 What are the useful scales for assessing cognitive impairment in dementia?

CQ 2-4 What are the useful rating scales for behavioral and psychological symptoms of dementia (BPSD), activities of daily living (ADL), and global severity?

CQ 2-5 How is quality of life (QOL) evaluated in persons with dementia?

CQ 2-6 How is primary progressive aphasia (PPA) classified and evaluated?

CQ 2-7 How is dementia diagnosed and differentiated?

CQ 2-8 How are imaging examinations carried out in dementia?

CQ 2-9 What are the useful blood and cerebrospinal fluid tests for the diagnosis of dementia?

CQ 2-10 Which physical and neurological findings require attention when diagnosing dementia?

CQ 2-11 What are the drugs that affect the diagnosis of dementia?

CQ 2-12 Are there useful genetic tests for the diagnosis of dementia?

Chapter 3 TreatmentPDF

A | Overview of Treatment

CQ 3A-1 How should interventions and support be given following a diagnosis of dementia?

CQ 3A-2 How should pharmacotherapy, non-pharmacologic interventions and care be provided during treatment of dementia?

CQ 3A-3 What are the principles and precautions of pharmacotherapy in older people with dementia?

CQ 3A-4 What are the adverse events of psychotropic drugs [such as falls, declined activity of daily living (ADL), cognitive impairment, and aspiration pneumonia]?

CQ 3A-5 What are the treatment procedures when using pharmacotherapy for dementia?

CQ 3A-6 What are the adverse events due to cholinesterase inhibitors and NMDA receptor antagonists, and what should be done in case of these events?

CQ 3A-7-1 What are the non-pharmacological therapies for dementia?

CQ 3A-7-2 What are the symptoms that respond to non-pharmacological therapies for dementia?

B | Treatment for behavioral and psychological symptoms of dementia (BPSD)

CQ 3B-1 What are the effective non-pharmacological therapies and pharmacotherapy for anxiety?

CQ 3B-2 What are the effective non-pharmacological therapies and pharmacotherapy for agitation?

CQ 3B-3 What are the effective non-pharmacological therapies and pharmacotherapy for hallucinations and delusions?

CQ 3B-4 What are the effective non-pharmacological therapies and pharmacotherapy for depression?

CQ 3B-5 What are the effective non-pharmacological therapies and pharmacotherapy for wandering?

CQ 3B-6 What are the effective non-pharmacological therapies and pharmacotherapy for sleep disturbance (excluding REM sleep behavior disorder)?

CQ 3B-7 What are the effective non-pharmacological therapies and pharmacotherapy for apathy?

C | Interventions for Coexisting Diseases

CQ 3C-1 How is delirium treated?

CQ 3C-2 How epilepsy including seizures should be treated in patients with dementia?

CQ 3C-3 What are the interventions for dysphagia (including prevention of aspiration pneumonia)?

CQ 3C-4 What are the interventions for eating disorder and undernutrition?

CQ 3C-5 What are the interventions for sarcopenia and frailty?

CQ 3C-6 What are the interventions and preventive measures for falls and fractures?

CQ 3C-7 What are the interventions for pressure ulcers?

CQ 3C-8 What are the approaches to treat acute physical illness?

CQ 3C-9 How should decisions be made regarding invasive examinations and treatments including dialysis and dental treatment?

CQ 3C-10 What are the interventions for edema?

CQ 3C-11 What are the interventions for urinary disorder?

CQ 3C-12 What are the interventions for constipation?

CQ 3C-13 How should diabetes, hypertension and other lifestyle-related diseases be managed?

Chapter 4 Clinical Course and TreatmentPDF

A | Risk Factors and Protective Factors of Dementia

CQ 4A-1 What are the risk factors and protective factors of dementia?

CQ 4A-2 Are hypertension control and antihypertensive drugs effective in dementia prevention?

CQ 4A-3 Is diabetes control effective in dementia prevention?

CQ 4A-4 Is treatment for dyslipidemia effective for dementia prevention?

CQ 4A-5 Does metabolic syndrome worsen dementia?

CQ 4A-6 Does smoking worsen dementia?

CQ 4A-7 Is exercise effective in preventing dementia?

CQ 4A-8 Are leisure activities, social participation, mental activities, cognitive training, and artistic activities such as music effective in preventing dementia and cognitive decline in older people?

CQ 4A-9 Are there dietary factors associated with dementia?

CQ 4A-10 Is moderate drinking effective in preventing cognitive decline and dementia?

CQ 4A-11 Does sleep apnea syndrome worsen cognitive function?

CQ 4A-12 Are depression and bipolar disorder risk factors for dementia?

B | Mild Cognitive Impairment

CQ 4B-1 What are the prevalence and incidence of mild cognitive impairment (MCI)?

CQ 4B-2 What is the conversion rate from mild cognitive impairment (MCI) to dementia, and the reversion rate from MCI to cognitive normal?

CQ 4B-3 What are the useful biomarkers for predicting conversion of mild cognitive impairment (MCI) to dementia?

CQ 4B-4 What rating scales are recommended when mild cognitive impairment (MCI) is suspected?

CQ 4B-5 How is mild cognitive impairment (MCI) diagnosed?

CQ 4B-6 Are there methods to prevent progression from mild cognitive impairment (MCI) to dementia?

CQ 4B-7 What kinds of guidance and support are available for people with mild cognitive impairment (MCI)?

C | Disease Severity and Interventions According to Severity

CQ 4C-1 What kind of guidance and support can be given to persons with mild to moderate dementia?

CQ 4C-2 What kind of guidance and support can be given to caregivers of persons with mild to moderate dementia?

CQ 4C-3 What kind of guidance and support can be given to persons with severe dementia?

CQ 4C-4 What kind of guidance and support can be given to caregivers of persons with severe dementia?

CQ 4C-5 How should end-of-life care be given to persons with dementia?

Chapter 5 Various Systems and Social Resources for Supporting Persons with Dementia and Their FamiliesPDF

A | Various Systems and Social Resources for Supporting Medical and Long-term Care for Persons with Dementia

CQ 5A-1 What are the functions and roles of the medical center for dementia?

CQ 5A-2 What are the roles of certified dementia support doctors?

CQ 5A-3 What are the roles of long-term care insurance system for persons with dementia and their caregivers?

CQ 5A-4 What are the functions and roles of Community General Support Center?

CQ 5A-5 What are the functions and roles of the initial-phase intensive support team for dementia?

B | Advocacy for People with Dementia

CQ 5B-1 Is it possible to evaluate the abilities of judgment and decision-making in persons with dementia?

CQ 5B-2 How can the adult guardianship system be used to protect the rights of people with dementia?

CQ 5B-3 What role does the Prevention of Elder Abuse Act play in preventing abuse to persons with dementia?

C | Early-onset Dementia

CQ 5C-1 What is early-onset dementia?

CQ 5C-2 What are the support systems to help persons with early-onset dementia with their economic challenges?

CQ 5C-3 What are the systems that can be used to support the living of persons with early-onset dementia?

CQ 5C-4 What kind of consultation support is available for persons with early-onset dementia?

D | Road Traffic Act

CQ 5D-1 What should be done if one finds that a person diagnosed with dementia holds a driver license and is still driving?

Chapter 6 Alzheimer’s Disease DementiaPDF

Preface

CQ 6-1 What are the features and key points of diagnosis for neuropsychiatric symptoms in Alzheimer’s disease dementia?

CQ 6-2 What are the diagnostic criteria for Alzheimer’s disease dementia?

CQ 6-3 What are the characteristic image findings of Alzheimer’s disease dementia?

CQ 6-4 Is APOE genetic testing useful for the diagnosis of Alzheimer’s disease dementia?

CQ 6-5 What are the useful biomarkers for the diagnosis of Alzheimer’s disease dementia?

CQ 6-6 Is amyloid PET examination useful for the diagnosis of Alzheimer’s disease dementia?

CQ 6-7 What are the pharmacotherapy and treatment algorithms for Alzheimer’s disease dementia?

CQ 6-8 What are the effects of non-pharmacological therapies for Alzheimer’s disease dementia?

CQ 6-9 What are the key points in care for Alzheimer’s disease dementia?

CQ 6-10 What kind of social support is available for Alzheimer’s disease dementia?

Chapter 7 Dementia with Lewy bodiesPDF

CQ 7-1 What are the diagnostic criteria and key points for early diagnosis of dementia with Lewy bodies (DLB)?

CQ 7-2 What are the clinical and pathological differences between dementia with Lewy bodies (DLB) and Parkinson’s disease with dementia (PDD)?

CQ 7-3 What are the characteristic laboratory and imaging biomarker of dementia with Lewy bodies (DLB)?

CQ 7-4 What are the clinical course and prognosis of dementia with Lewy bodies (DLB)?

CQ 7-5 What is the treatment strategy planned for dementia with Lewy bodies (DLB)?

CQ 7-6 Are there any drugs for the treatment of cognitive impairment in dementia with Lewy bodies (DLB)?

CQ 7-7 Are there any treatments for behavioral and psychological symptoms of dementia (BPSD) and REM sleep behavior disorder (RBD) in dementia with Lewy bodies (DLB)?

CQ 7-8 Are there any treatments for autonomic symptoms (such as orthostatic hypotension, constipation, sweating, urination disorder) in dementia with Lewy bodies (DLB)?

CQ 7-9 What are the suitable treatments for parkinsonism in dementia with Lewy bodies (DLB)?

CQ 7-10 What are the non-pharmacological interventions for dementia with Lewy bodies (DLB)?

Chapter 8 Frontotemporal Lobar DegenerationPDF

Preface

CQ 8-1 What are the diagnostic key points and diagnostic criteria for frontotemporal lobar degeneration (FTLD)?

CQ 8-2 What are the characteristics of image findings of frontotemporal lobar degeneration (FTLD)?

CQ 8-3 Are there effective drugs for frontotemporal lobar degeneration (FTLD)?

CQ 8-4 Are there effective non-pharmacological therapies for frontotemporal lobar degeneration (FTLD)?

CQ 8-5 What kind of instructions should be given to families and caregivers of frontotemporal lobar degeneration (FTLD) patients?

Chapter 9 Progressive Supranuclear Palsy (PSP)PDF

Preface

CQ 9-1 What are the features of dementia symptoms in progressive supranuclear palsy (PSP)?

CQ 9-2 Are there useful therapies for cognitive impairment in progressive supranuclear palsy (PSP)?

Chapter 10 Corticobasal DegenerationPDF

Preface

CQ 10-1 What are the features of cognitive impairment in corticobasal degeneration (CBD), and what are the test methods?

CQ 10-2 Are there effective pharmacological and non-pharmacological therapies for cognitive impairment in corticobasal degeneration (CBD)?

Chapter 11 Argyrophilic Grain DementiaPDF

CQ 11-1 What is the frequency of argyrophilic grain disease (AGD)?

CQ 11-2 How is a clinical diagnosis made for argyrophilic grain dementia?

CQ 11-3 What kinds of treatments are available for argyrophilic grain dementia?

Chapter 12 Senile Dementia of the Neurofibrillary Tangle TypePDF

CQ 12-1 What kind of disease is senile dementia of the neurofibrillary tangle type (SD-NFT)?

Chapter 13 Huntington DiseasePDF

CQ 13-1 What are the features and diagnosis of cognitive symptoms in Huntington disease?

Chapter 14 Vascular DementiaPDF

CQ 14-1 What are the diagnostic criteria for vascular dementia (VaD)?

CQ 14-2 How are the types of vascular dementia (VaD) classified?

CQ 14-3 What are the imaging features of vascular dementia (VaD)?

CQ 14-4 What is the condition when vascular dementia (VaD) coexists with Alzheimer’s disease dementia?

CQ 14-5 What are the clinical course and prognosis of vascular dementia (VaD)?

CQ 14-6 What are the systemic complications and associated symptoms of vascular dementia (VaD)?

CQ 14-7 What are the risk factors for vascular dementia (VaD) and how are they controlled?

CQ 14-8 What is antithrombotic therapy for vascular dementia (VaD)?

CQ 14-9 Are there effective drugs for cognitive impairment in vascular dementia (VaD)?

CQ 14-10 What is the clinical position of cerebral amyloid angiopathy (CAA)?

Chapter 15 Prion DiseasePDF

CQ 15-1 What are the clinical features of sporadic Creutzfeldt-Jakob disease (CJD)?

CQ 15-2 What are the electroencephalographic, cerebrospinal fluid, and MRI findings of sporadic Creutzfeldt-Jakob disease (CJD)?

CQ 15-3 What are the types and features of genetic prion disease in Japan?

CQ 15-4 What are the types and features of acquired (infectious) prion disease in Japan?

CQ 15-5 What are the infection control measures and effective sterilization methods for prion disease?

Chapter 16 Medical Diseases and OthersPDF

CQ 16-1 What are the features of cognitive impairment due to vitamin deficiency?

CQ 16-2 What are the features of cognitive impairment due to hypothyroidism?

CQ 16-3 What are the features of cognitive decline due to neurosyphilis?

CQ 16-4 What are the features of cognitive impairment caused by hepatic encephalopathy (HE)?

CQ 16-5 What are the features, diagnosis, and treatment strategies for dementia symptoms of idiopathic normal pressure hydrocephalus (iNPH)?