Embargoed news from Oct. 22, 2013 Annals of Internal Medicine tip sheet

October 21, 2013

1. ACP recommends against routine screening for chronic kidney disease

ACP's new guideline presents evidence-based recommendations for screening, monitoring, and treatment of adults with stage 1-3 chronic kidney disease

Finding no direct evidence that addresses the benefits of screening for stage 1-3 chronic kidney disease (CKD) and citing potential harms of tests, the American College of Physicians (ACP) recommends against screening for CKD in asymptomatic adults without risk factors. ACP found the evidence inconclusive for CKD screening in asymptomatic adults with risk factors and for periodic monitoring of patients diagnosed with stage 1-3 CKD. Major risk factors for CKD include diabetes, hypertension, and cardiovascular disease. Based on the evidence, ACP recommends against testing for proteinuria in adults with or without diabetes who are currently taking an angiotensin-converting-enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB). ACP recommends treating patients with hypertension and stage 1-3 CKD with either an ACE inhibitor or an ARB. ACP recommends a statin therapy to manage elevated low density lipoprotein in patients with stage 1-3 CKD. Head-to-head trials showed no difference in the outcomes between ACE inhibitors or ARBs. The risk of adverse effects significantly increased with an ACE inhibitor combined with an ARB combination therapy, including cough, hyperkalemia, hypotension, and acute kidney failure requiring dialysis. ACP's guideline also includes advice to help physicians practice high value care.

Note: For an embargoed PDF, please contact Megan Hanks or Angela Collom. To speak with the lead author, please contact Steve Majewski at smajewski@acponline.org or 215-351-2514.

2. Screening may adequately detect early dementia, but benefit is still unknown

A review of published evidence suggests that brief screening tests for cognitive impairment that can be implemented in the primary care setting may be useful for detecting dementia. However, there is no evidence that early diagnosis of cognitive impairment improves decision-making or outcomes. Mild cognitive impairment is a decline in cognitive function that is not severe enough to interfere with independence in daily life, however it may be useful in predicting dementia. Earlier identification and medical management of cognitive impairment may improve prognosis and decrease patient and caregiver morbidity. Researchers reviewed published research on the diagnostic accuracy of brief cognitive screening instruments and the benefits and harms of pharmacologic and nonpharmacologic interventions for early cognitive impairment. Evidence suggests that several brief screening tools are effective at detecting cognitive impairment, but only a few of them were studied in more than one study applicable to primary care. There was not enough published evidence to adequately assess the potential harms associated with screening and no trials directly assessed whether screening could affect decision-making, patient or caregiver, or societal outcomes. Based on the evidence, it was also unclear whether medications, caregiver interventions, cognitive interventions, or exercise interventions in persons with earlier detected cognitive impairment would have a clinically significant effect on outcomes. The evidence review was conducted by researchers for the United States Preventive Services Task Force (USPSTF) to update its previous recommendation. In 2003, the USPSTF found insufficient evidence to recommend for or against routine screening for dementia in older adults.

Note: For an embargoed PDF, please contact Megan Hanks or Angela Collom. To speak with the lead author, please contact Mary Sawyers at mary.a.sawyers@kpchr.org or 503-335-6602.

American College of Physicians

Related Dementia Articles from Brightsurf:

The danger of Z-drugs for dementia patients
Strong sleeping pills known as 'Z-drugs' are linked with an increased risk of falls, fractures and stroke among people with dementia, according to new research.

The long road to dementia
Alzheimer's disease develops over decades. It begins with a fatal chain reaction in which masses of misfolded beta-amyloid proteins are produced that in the end literally flood the brain.

Why people with dementia go missing
People with dementia are more likely to go missing in areas where road networks are dense, complicated and disordered - according to new research from the University of East Anglia.

PTSD may double risk of dementia
People who have experienced post-traumatic stress disorder (PTSD) are up to twice as likely to develop dementia later in life, according to a new study by UCL researchers, published in the British Journal of Psychiatry.

Dementia education
School-based dementia education could deliver much needed empathy and understanding for older generations as new research from the University of South Australia shows it can significantly improve dementia knowledge and awareness among younger generations.

Building dementia friendly churches
A project to help church communities become more 'dementia friendly' has had a significant impact across the country.

A "feeling" for dementia?
A research team led by the DZNE concludes that personal perception can be an important indicator for the early detection of Alzheimer's disease.

New biomarker for dementia diagnosis
Medical researchers in the UK and Australia have identified a new marker which could support the search for novel preventative and therapeutic treatments for dementia.

Digital solutions for dementia care
Telehealth delivery of dementia care in the home can be as effective as face-to-face home visit services if carers and recipients take advantage of the technologies available, Australian researchers say.

Despite a marked reduction in the prevalence of dementia, the number of people with dementia is set to double by 2050 according to new Alzheimer Europe report
Today, at a European Parliament lunch debate, Alzheimer Europe launched a new report presenting the findings of its collaborative analysis of recent prevalence studies and setting out updated prevalence rates for dementia in Europe.

Read More: Dementia News and Dementia Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.