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Centre for Policy on Ageing | |
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| International Psychogeriatric Association consensus statement on defining and measuring treatment benefits in dementia | | Author(s) | Cornelius Katona, Gill Livingston, Claudia Cooper |
| Corporate Author | Consensus Group, International Psychogeriatric Association - IPA |
| Journal title | International Psychogeriatrics, vol 19, no 3, June 2007 |
| Pages | pp 345-354 |
| Keywords | Dementia ; Medical care ; Psychiatric treatment ; Econometrics ; Standards of provision ; International. |
| Annotation | Current symptomatic treatments for dementia have only modest efficacy. Assessing meaningful benefits in this variably progressive syndrome is complex and difficult. This consensus statement was generated by an international group representing caregivers, organisations and professionals with expertise in dementia. The authors write on behalf of the Consensus Group to recommend the statement of clear, pre-defined diagnostic and severity criteria and outcomes measures, which include functional and executive capacity, in treatment trials. Outcomes can include effects on people with dementia (PWD) with regard to cognition, behavioural and psychological symptoms, quality of life, global assessments, and activities of daily living (ADLs), and must be tailored to participants' education and culture. Outcomes can also appropriately encompass effects on caregivers. New instruments may be needed, as validation of many existing measures has been in relatively homogeneous populations. Treatment goals can be to prevent dementia emerging, or in those with established dementia to slow deterioration, and to postpone, stabilise or improve symptoms. Comparisons between treatment groups should be on the basis of technically relevant measures with both risk and benefit reported for all participants regardless of whether or not they continue to receive treatment throughout the trial. To date, characterisation of any groups that respond well to treatment has been unsuccessful, but may be facilitated in the future by measurement of putative biomarkers. Despite recent progress and several "candidate" biomarkers, none is yet satisfactory for determining diagnosis, severity, progression or prediction of response. To provide meaningful data, economic analyses should use up-to-date country-specific data. Health economic measures should be incorporated as secondary outcomes in all Phase 3 trials, since health systems are concerned with cost-effectiveness as well as clinical outcome. However, health utility measures are not validated satisfactorily in dementia, thus calling into question previous health economic analyses. While current drugs appear to reduce the amount of family caregiver time required by PWD, in the main, these costs fall on older individuals who often exert little political leverage, rather than on society at large. Traditionally, older people have been marginalised in the political process. The growth in the older population worldwide, and their potential for increasing political empowerment may lead to a radical re-evaluation of the economics of treatment in dementia. (RH). |
| Accession Number | CPA-090825205 A |
| Classmark | EA: LK: LP: WE: 583: 72 |
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| ...from the Ageinfo database published by Centre for Policy on Ageing. |
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