Guideline for primary care management of dementia
Authors: T. Marshall, R. Eastley, J. Haworth, G. Wilcock, D. Sharp, W. G Tapsfield, D. M Jelley, H Matthews, D Wilkinson, C Holmes, M. Eccles, J. Clarke, M. Livingstone, N. Freemantle, J. Mason
Journal: BMJ (1999)

# Such guidelines should consider all relevant effective treatments {#article-title-2} EDITOR—Evidence based guidelines have a responsibility to consider all the relevant effective treatments and not to concentrate only on those with which clinicians are familiar. I was surprised by a serious omission from the North of England evidence based guidelines for the primary care management of dementia1 —of category I evidence for the effectiveness of Ginkgo biloba extract in dementia, from a large randomised controlled trial.2 The number needed to treat for a 4 point improvement in the cognitive subscale of the Alzheimer's disease assessment scale at one year of follow up has been calculated as 7.9 (95% confidence interval 4.2 to 67); for a significant improvement in the geriatric assessment by relative's rating instrument (a daily living and social behaviour score assessed by family members) it was 7.0 (3.3 to 97). The dose of G biloba extract was 120 mg a day.3 G biloba extract is available over the counter, and the cost of a year's treatment (from one major supermarket) is £85. A year's treatment with donepezil, by contrast, costs £891 for 5 mg and £1248 for 10 mg. 1. 1.↵1. Eccles M, 2. Clarke J, 3. Livingstone M, 4. Freemantle N, 5. Mason J for the North of England Evidence Based Dementia Guideline Development Group North of England evidence based guidelines development project: guideline for the primary care management of dementia. BMJ 1998; 317: 802–808. (19 September.) [OpenUrl][1][FREE Full Text][2] 2. 2.↵1. Le Bars PL, 2. Katz MM, 3. Berman N, 4. Itil TM, 5. Freedman AM, 6. Schatzberg AF for the North American RGb Study Group A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. JAMA 1997; 278: 1327–1332. [OpenUrl][3][CrossRef][4][PubMed][5][Web of Science][6] 3. 3.↵Dementia: diagnosis and treatment. Bandolier 1998; 5(2): 2–3. [OpenUrl][7] # Guideline should cover differential diagnosis {#article-title-6} EDITOR—The summary version of the guideline for primary care management of dementia is inadequate and in some respects inaccurate.1 Not to cover differential diagnosis is a major omission; treatments for Alzheimer's disease now exist, and general practitioners and the primary healthcare team need to identify patients with vascular dementia and cognitive impairment (many such patients have treatable risk factors) as well as those with Lewy body dementia (for which diagnostic advice is in fact provided). The guideline should at least have recommended referral to specialist services, since distinguishing between the dementias is one of our most important clinical problems and an area where guidelines are most urgently required. Advice about when … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DEccles%26rft.auinit1%253DM.%26rft.volume%253D317%26rft.issue%253D7161%26rft.spage%253D802%26rft.epage%253D808%26rft.atitle%253DNorth%2Bof%2BEngland%2Bevidence%2Bbased%2Bguidelines%2Bdevelopment%2Bproject%253A%2Bguideline%2Bfor%2Bthe%2Bprimary%2Bcare%2Bmanagement%2Bof%2Bdementia%26rft_id%253Dinfo%253Apmid%252F9740574%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=317/7161/802&atom=%2Fbmj%2F318%2F7185%2F731.atom [3]: {openurl}?query=rft.jtitle%253DJAMA%26rft.stitle%253DJAMA%26rft.issn%253D0002-9955%26rft.aulast%253DLe%2BBars%26rft.auinit1%253DP.%2BL.%26rft.volume%253D278%26rft.issue%253D16%26rft.spage%253D1327%26rft.epage%253D1332%26rft.atitle%253DA%2BPlacebo-Controlled%252C%2BDouble-blind%252C%2BRandomized%2BTrial%2Bof%2Ban%2BExtract%2Bof%2BGinkgo%2BBiloba%2Bfor%2BDementia%26rft_id%253Dinfo%253Adoi%252F10.1001%252Fjama.1997.03550160047037%26rft_id%253Dinfo%253Apmid%252F9343463%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/external-ref?access_num=10.1001/jama.1997.03550160047037&link_type=DOI [5]: /lookup/external-ref?access_num=9343463&link_type=MED&atom=%2Fbmj%2F318%2F7185%2F731.atom [6]: /lookup/external-ref?access_num=A1997YA90500033&link_type=ISI [7]: {openurl}?query=rft.jtitle%253DBandolier%26rft.volume%253D5%26rft.issue%253D2%26rft.spage%253D2%26rft.atitle%253DDEMENTIA%253A%2BDIAGNOSIS%2BAND%2BTREATMENT%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx