Download PDF
Fortschr Neurol Psychiatr 2003; 71(6): 285-295
DOI: 10.1055/s-2003-39595
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Nationale und internationale Demenz-Leitlinien im Vergleich

A Systematic Comparison of National and International Dementia GuidelinesU.  Müller1 , H.  Wolf1, 2 , M.  Kiefer1 , H.-J.  Gertz1
  • 1Klinik und Poliklinik für Psychiatrie, Universität Leipzig
  • 2Department of Clinical Neuroscience (NEUROTEC), Karolinska Institutet, Division of Geriatric Medicine, Huddinge University Hospital
Die Arbeit wurde gefördert durch das Bundesministerium für Bildung und Forschung (BMBF) und das Interdisziplinäre Zentrum für Klinische Forschung (IZKF) der Medizinischen Fakultät der Universität Leipzig, Projekt C-8.
Further Information

Publication History

Publication Date:
10 June 2003 (online)

    Permissions and Reprints

Zusammenfassung

In den letzten Jahren wurden in Deutschland und weltweit zahlreiche Leitlinien zur evidenzbasierten Diagnostik und Therapie demenzieller Erkrankungen publiziert. In der vorliegenden Arbeit werden 13 aktuelle Demenz-Leitlinien inhaltlich ausgewertet und ihre methodische Qualität systematisch bewertet. Es finden sich einige unumstrittene Empfehlungen zur Diagnostik (z. B. klinische Untersuchung, neuropsychologisches Screening, strukturelle Bildgebung) und Therapie (z. B. Acetylcholinesterasehemmer bei Alzheimer-Krankheit). Andere Verfahren (z. B. Routine-EEG, FDG-PET, kognitives Training) werden sehr unterschiedlich bewertet. Abschließend wird die Problematik des aktuellen Leitlinien-Pluralismus diskutiert und Empfehlungen für regional angepasste, internationale Leitlinien ausgesprochen.

Abstract

Several guidelines for the evidence-based diagnosis and treatment of dementing disorders have been published in Germany and worldwide during the last years. This review analyses the content and methodological quality of 13 recently published dementia guidelines. There are some unequivocal recommendations for diagnostic procedures (e. g. clinical evaluation, neuropsychological screening, structural brain imaging) and treatment (e. g. cholinesterase inhibitors). There is a broad range of opinions on other procedures (e. g. routine EEG, FDG PET, cognitive training). A discussion of the prevalent guideline pluralism and a pleading for regionally adapted international guidelines conclude this article.

Literatur

  • 1 Kanowski S, Igl G, Bartholomeyczik S, Brenner H, Großjohann K, Ihl R, Kuhlmey , Schreiber H L, Steinhagen-Thiessen E, Tesch-Römer C, Weyerer S, Wojnar J. Vierter Altenbericht zur Lage der älteren Generation in der Bundesrepublik Deutschland. Risiken, Lebensqualität und Versorgung Hochaltriger - unter besonderer Berücksichtigung demenzieller Erkrankungen. Berlin: Bundesministerium für Familie, Senioren, Frauen und Jugend 2002
    Google Scholar
  • 2 Oakley-Browne M A. EBM in practice: psychiatry.  Med J Australia. 2001;  174 403-404
    PubMedGoogle Scholar
  • 3 Lasek R, Müller-Oerlinghausen B. Therapieempfehlungen der Arzneimittelkommission der deutschen Ärzteschaft - Ein Instrument zur Qualitätssicherung in der Arzneimitteltherapie.  Z Ärztl Fortbild Qualitätssich. 1997;  91 375-383
    PubMedGoogle Scholar
  • 4 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) und die Ärztliche Zentralstelle für Qualitätssicherung (ÄZQ) . Das Leitlinien-Manual von AWMF und ÄZQ.  Z Ärztl Fortb Qualitätssicherung. 2001;  95 (Suppl 1) 1-84
    PubMedGoogle Scholar
  • 5 Petersen R C, Stevens J C, Ganguli M, Tangalos E G, Cummings J L, DeKosky S T. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology. 2001;  56 1133-1142 [AAN]*
    PubMedGoogle Scholar
  • 6 Knopman D S, DeKosky S T, Cummings J L, Chui H, Corey-Bloom J, Relkin N, Small G W, Miller B, Stevens J C. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology. 2001;  56 1143-1153 [AAN]*
    CrossrefPubMedGoogle Scholar
  • 7 Doody R S, Stevens J C, Beck C, Dubinsky R M, Kaye J A, Gwyther L, Mohs R C, Thal L J, Whitehouse P J, DeKosky S T, Cummings J L. Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology. 2001;  56 1154-1166 [AAN]*
    PubMedGoogle Scholar
  • 8 Grilli R, Magrini N, Penna A, Mura G, Liberati A. Practice guidelines developed by specialty societies: the need for a critical appraisal.  Lancet. 2000;  355 103-106
    CrossrefPubMedGoogle Scholar
  • 9 Härter M, Bermejo I, Aschenbrenner A, Berger M. Analyse und Bewertung aktueller Leitlinien zur Diagnostik und Behandlung depressiver Störungen.  Fortschr Neurol Psychiat. 2001;  69 390-401
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Wallesch C W. Leitlinien zur Diagnostik bei Patienten mit Demenz.  Akt Neurol. 2001;  28 201-207
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Waldemar G, Dubois B, Emre M, Scheltens P, Tariska P, Rossor M. Diagnosis and management of Alzheimer's disease and other disorders associated with dementia. The role of neurologists in Europe. European Federation of Neurological Societies Scientist Panel on Dementia.  Eur J Neurol. 2000;  7 133-144 [EFNS]*
    PubMedGoogle Scholar
  • 12 Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines.  Br Med J. 2001;  323 334-336
    PubMedGoogle Scholar
  • 13 Scottish Intercollegiate Guidelines Network. SIGN 50 .A Guideline Developers' Handbook. Edinburgh: SIGN 2002: (www.sign.ac.uk)
    Google Scholar
  • 14 Small G W, Rabins P V, Barry P P, Buckholtz N S, DeKosky S T, Ferris S H, Finkel S I, Gwyther L P, Khachaturian Z S, Lebowitz B D, McRae T D, Morris J C, Oakley F, Schneider L S, Streim J E, Sunderland T, Teri L A, Tune L E. Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society.  J Am Med Assoc. 1997;  278 1363-1371
    CrossrefPubMedGoogle Scholar
  • 15 Wallin A, Brun A, Gustafson L. Swedish Consensus on Dementia Diseases (Acta Neurologica Scandinavica Supplement 157). Køpenhagen: Munksgaard 1994
    Google Scholar
  • 16 Scottish Intercollegiate Guidelines Network (SIGN) .Interventions in the Management of Behavioural and Psychological Aspects of Dementia: A National Clinical Guideline recommended for use in Scotland. Edinburgh: SIGN 1998: (www.sign.ac.uk)
    Google Scholar
  • 17 Cummings J L, Frank J C, Cherry D, Kohatsu N D, Kemp B, Hewett L, Mittman B. Guidelines for managing Alzheimer's disease: part I. Assessment.  Am Fam Physician. 2002;  65 2263-2272
    PubMedGoogle Scholar
  • 18 Cummings J L, Frank J C, Cherry D, Kohatsu N D, Kemp B, Hewett L, Mittman B. Guidelines for managing Alzheimer's disease: Part II. Treatment.  Am Fam Physician. 2002;  65 2525-2534
    PubMedGoogle Scholar
  • 19 American Academy of Neurology . Practice parameter for diagnosis and evaluation of dementia (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology. 1994;  44 2203-2206 [AAN]*
    PubMedGoogle Scholar
  • 20 Dubinsky R M, Stein A C, Lyons K. Practice parameter: risk of driving and Alzheimer's disease (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology.  Neurology. 2000;  54 2205-2211
    PubMedGoogle Scholar
  • 21 Gifford D R, Holloway R G, Frankel M R, Albright C L, Meyerson R, Griggs R C, Vickrey B G. Improving adherence to dementia guidelines through education and opinion leaders. A randomized, controlled trial.  Ann Intern Med. 1999;  131 237-246
    CrossrefPubMedGoogle Scholar
  • 22 Holloway R G, Gifford D R, Frankel M R, Vickrey B G. A randomized trial to implement practice recommendations: design and methods of the Dementia Care Study.  Control Clin Trials. 1999;  20 369-385
    PubMedGoogle Scholar
  • 23 Work Group on Alzheimer's Disease and Related Dementias .Practice Guideline for the Treatment of Patients with Alzheimer's Disease and other Dementias of Late Life (American Journal of Psychiatry Supplement). Washington: APA Press 1997: [APA]*
    Google Scholar
  • 24 Rabins P, Blan W, Bright-Long L, Cohen E, Katz I, Rovner B, Schneider L, Blacker D. Practice guideline for the treatment of patients with Alzheimer's disease and other dementias of late life. In: American Psychiatric Association (Hrsg). Guidelines for the Treatment of Psychiatric Disorders: Compendium 2002. Washington: American Psychiatric Press 2002: 67-135 [APA]*
    Google Scholar
  • 25 American Psychiatric Association .Practice guideline development process. In: American Psychiatric Association (Hrsg). Guidelines for the Treatment of Psychiatric Disorders: Compendium 2002. Washington: American Psychiatric Press 2002: 857-863 [APA]*
    Google Scholar
  • 26 Sainsbury R, Collins C, Duff G, Harrison J, Haydon R, Wilkinson T. Guidelines for the Support and Management of People with Dementia. Wellington: New Zealand Guidelines Group 1988: (www.nzgg.org.nz) [NZGG]*
    Google Scholar
  • 27 Milne R J. National Guidelines Committee for Acetylcholinesterase Inhibitors .Guidelines for the Use of Acetylcholinesterase Inhibitor Drugs in the Treatment of People with Alzheimer's Disease. Wellington: New Zealand Guidelines Group 2000: (www.nzgg.org.nz) [NZGG]*
    Google Scholar
  • 28 Patterson C J, Gauthier S, Bergman H, Cohen C A, Feightner J W, Feldman H, Hogan D B. The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia.  Can Med Assoc J. 1999;  160 (12 Suppl) 1-15 [CCCD]*
    PubMedGoogle Scholar
  • 29 Patterson C J, Gauthier S, Bergman H, Cohen C A, Feightner J W, Feldman H, Hogan D B. Canadian Consensus Conference on Dementia: a physician's guide to using the recommendations.  Can Med Assoc. 1999;  160 1738-1742
    PubMedGoogle Scholar
  • 30 Patterson C, Gauthier S, Bergman H, Cohen C, Feightner J W, Feldman H, Grek A, Hogan D B. The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia.  Can J Neurol Sci. 2001;  28 (Suppl 1) 3-16 [CCCD]*
    PubMedGoogle Scholar
  • 31 Hogan D B, Jennett P, Freter S, Bergman H, Chertkow H, Gold S, Clarfield A M. Recommendations of the Canadian Consensus Conference on Dementia - dissemination, implementation, and evaluation of impact.  Can J Neurol. 2001;  28 (Suppl 1) 115-121
    PubMedGoogle Scholar
  • 32 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (Hrsg) .Behandlungsleitlinie Demenz (Praxisleitlinien in Psychiatrie und Psychotherapie 3). Darmstadt: Steinkopff 2000: [DGPPN]*
    Google Scholar
  • 33 Petit H, Albarède J L, Bakchine S, Boulliat J, Cogneau J, Darcourt G, Dubois B, Forette F, Franco A, Héres J, Hinault P, Laurent B, Léger J M, Marin L a, Montagne B, Poncet M, Robert P, Sorbé G, Touchon J, Velas B, Vetel J M. Convergences d'un groupe pluridisciplinaire d'experts français sur les modalités du diagnostic et des thérapeutiques de la maladie d'Alzheimer au stade démentiel.  Rev Neurol. 2000;  156 542-552 [GEMA]*
    PubMedGoogle Scholar
  • 34 The Dementia Study Group of the Italian Neurological Society . Guidelines for the diagnosis of dementia and Alzheimer's disease.  Neurol Sci. 2000;  21 187-194 [SIN]*
    CrossrefPubMedGoogle Scholar
  • 35 Arzneimittelkommission der deutschen Ärzteschaft .Empfehlungen zur Therapie der Demenz (Arzneiverordnungen in der Praxis). Köln: Arzneimittelkommission der deutschen Ärzteschaft 2001: (www.akdae.de) [AkdÄ]*
    Google Scholar
  • 36 National Institute for Clinical Excellence .Guidance for the use of donepezil, rivastigmine and galantamine for the treatment of Alzheimer's disease (Technical Appraisal Guidance 19). London: National Institute for Clinical Excellence 2001: (www.nice.org.uk) [NICE]*
    Google Scholar
  • 37 Ministry of Health .Clinical Practice Guidelines: Dementia. Singapore: Ministry of Health 2001: (www.gov.sg/moh/pub/cpg/cpg.htm) [MHS]*
    Google Scholar
  • 38 McKeith I, Del Ser T, Spano P, Emre M, Wesnes K, Anand R, Cicin-Sain A, Ferrara R, Spiegel R. Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study.  Lancet. 2000;  356 2031-2036
    CrossrefPubMedGoogle Scholar
  • 39 Robles A, Del Ser T, Alom J, Pena-Casanova J. Grupo Asesor del Grupo de Neurología de la Conducta y Demencias de la Sociedad Española de Neurología . Propuesta de criterios para el diagnóstico clínico del deterio cognitivo ligero, la demencia y la enfermedad de Alzheimer.  Neurología. 2002;  17 7-32 [SEN]*
    PubMedGoogle Scholar
  • 40 Diener H C, Hacke W. Leitlinien für Diagnostik und Therapie in der Neurologie. Herausgegeben für die Kommission „Leitlinien” der Deutschen Gesellschaft für Neurologie. Stuttgart: Thieme 2002: [DGN]*
    Google Scholar
  • 41 The AGREE Collaboration .Appraisal of Guidelines for Research & Evaluation: AGREE Instrument. London: St. George's Hospital Medical School 2001: (www.agreecollaboration.org)
    Google Scholar
  • 42 Scheltens P, Fox N, Barkhof F, De Carli C. Structural magnetic resonance imaging in the practical assessment of dementia: beyond exclusion.  Lancet Neurol. 2002;  1 13-21
    CrossrefPubMedGoogle Scholar
  • 43 Wolf H, Jelic V, Gertz H J, Nordberg A, Julin P, Wahlund L O. A critical discussion of the role of neuroimaging in mild cognitive impairment. Acta Neurol Scand Suppl 2003 179: 52-76
    Google Scholar
  • 44 McMahon P M, Araki S S, Neumann P J, Harris G J, Gazelle G S. Cost-effectiveness of functional imaging tests in the diagnosis of Alzheimer disease.  Radiology. 2000;  217 58-68
    PubMedGoogle Scholar
  • 45 Meyer G J, Waters S L, Coenen H H, Luxen A, Maziere B, Langstrom B. PET radiopharmaceuticals in Europe: current use and data relevant for the formulation of summaries of product characteristics (SPCs).  Eur J Nucl Med. 1995;  22 1420-1432
    PubMedGoogle Scholar
  • 46 Lyketsos C G, Olin J. Depression in Alzheimer's disease: overview and treatment.  Biol Psychiatry. 2002;  52 243-252
    CrossrefPubMedGoogle Scholar
  • 47 Hirsch R D. Sozio- und Psychotherapie bei Alzheimerkranken.  Z Gerontol Geriat. 2001;  34 92-100
    CrossrefPubMedGoogle Scholar
  • 48 Cluzeau F A, Littlejohns P, Grimshaw J M, Feder G, Moran S E. Development and application of a generic methodology to assess the quality of clinical guidelines.  Int J Qual Health Care. 1999;  11 21-28
    PubMedGoogle Scholar
  • 49 Rosen C S, Chow H C, Greenbaum M A, Finney J F, Moos R H, Sheikh J I, Yesavage J A. How well are clinicians following dementia practice guidelines?.  Alzheimer Dis Assoc Disord. 2002;  16 15-23
    CrossrefPubMedGoogle Scholar
  • 50 Seidman D. Compliance with guidelines is not the same as evidence-based medicine.  J Pediatr. 2001;  138 299-300
    PubMedGoogle Scholar
  • 51 Shekelle P, Eccles M P, Grimshaw J M, Woolf S H. When should clinical guidelines be updated?.  Br Med J. 2001;  323 155-157
    PubMedGoogle Scholar
  • 52 Shekelle P G, Woolf S H, Eccles M, Grimshaw J. Developing guidelines.  Br Med J. 1999;  318 593-596
    PubMedGoogle Scholar
  • 53 Erkinjuntti T, Kurz A, Gauthier S, Bullock R, Lilienfeld S, Damaraju C V. Efficacy of galantamine in probable vascular dementia and Alzheimer's disease combined with cerebrovascular disease: a randomised trial.  Lancet. 2002;  359 1283-1290
    CrossrefPubMedGoogle Scholar
  • 54 Orgogozo J M, Rigaud A S, Stoffler A, Mobius H J, Forette F. Efficacy and safety of memantine in patients with mild to moderate vascular dementia: a randomized, placebo-controlled trial (MMM 300).  Stroke. 2002;  33 1834-1839
    CrossrefPubMedGoogle Scholar
  • 55 Wilcock G, Mobius H J, Stoffler A. A double-blind, placebo-controlled multicentre study of memantine in mild to moderate vascular dementia (MMM500).  Int Clin Psychopharmacol. 2002;  17 297-305
    PubMedGoogle Scholar
  • 56 Winblad B, Poritis N. Memantine in severe dementia: results of the 9M-Best Study (Benefit and efficacy in severely demented patients during treatment with memantine).  Int J Geriatr Psychiatry. 1999;  14 135-146
    CrossrefPubMedGoogle Scholar
  • 57 Waegemans T, Wilsher C R, Danniau A, Ferris S H, Kurz A, Winblad B. Clinical efficacy of piracetam in cognitive impairment: a meta-analysis.  Dement Geriatr Cogn Disord. 2002;  13 217-224
    PubMedGoogle Scholar
  • 58 Lundberg N,. American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention . Guideline for the prevention of falls in older persons.  J Am Geriatr Soc. 2001;  49 664-672
    CrossrefPubMedGoogle Scholar
  • 59 Woolf S H, Grol R, Hutchinson A, Eccles M, Grimshaw J. Potential benefits, limitations, and harms of clinical guidelines.  Br Med J. 1999;  318 527-530
    CrossrefPubMedGoogle Scholar
  • 60 Weidinger P. Leitlinien und ärztliche Berufshaftpflicht.  Internist. 2001;  42 M118-123
    CrossrefPubMedGoogle Scholar
  • 61 Rossor M N. Dementia and driving: European National Guidelines. EFNS Scientist Panel on Dementia.  Eur J Neurol. 2000;  7 745
    CrossrefPubMedGoogle Scholar

1 kennzeichnet die systematisch ausgewerteten Leitlinien-Texte

PD Dr. med. Ulrich Müller

Klinik und Poliklinik für Psychiatrie, · Universität Leipzig

Liebigstr. 22

04103 Leipzig

Email: um207@cam.ac.uk

      >