Søgeprotokol for Nationale Kliniske Retningslinjer Projekttitel/aspekt NKR Demens - Medicin - Primærlitteratur (RCT) Fagkonsulent Anne Mette Skov Sørensen / Elisabeth Bandak Projektleder Casper Larsen Søgespecialist Kirsten Birkefoss Senest opdateret 18.04.2018 Fokuserede spørgsmål : Bør behandling med demenslægemidler seponeres hos PICO 1 personer med meget svær demens? PICO 2: Bør personer med demens i langvarig behandling med antipsykotisk medicin revurderes med henblik på om behandlingen skal fortsætte eller seponeres? PICO 3: Bør personer med demens og søvnbesvær og/eller døgnrytmeforstyrrelse behandles med melatonin? PICO 4: Bør personer med demens og søvnbesvær og/eller døgnrytmeforstyrrelse behandles med mirtazapin eller mianserin? PICO 5: Bør personer med demens i behandling med antidepressiva (> 6 måneder) revurderes med henblik på om behandlingen skal fortsætte eller seponeres? PICO 6: Bør behandling med urologiske spasmolytika med antikolinerg virkning undlades hos personer med demens? PICO 7: Bør man forsøge seponering af paracetamol ved usikker indikation hos personer med demens? PICO 8: Bør man forsøge seponering af opioider ved usikker indikation hos personer med demens? PICO 9: Bør behandlingsmålet for blodtryk være højere hos personer med moderat til svær demens > 80år? Søgetermer Se søgestrategierne under de enkelte PICOs/PIROs Inklusions- og Sprog: Engelsk, tysk, dansk, norsk og svensk eksklusionskriterier År: Se de enkelte PICOs Population: Voksne fra og med 18 år Publikationstyper: RCT 1 Informationskilder DATABASE INTERFACE DATO FOR SØGNING Medline OVID 26.01.2018 - 18.04.2018 EMBASE OVID 26.01.2018 - 18.04.2018 PsycINFO OVID 26.01.2018 - 09.03.2018 CINAHL EBSCO 26.01.2018 - 14.03.2018 Note • Søgetermer og inklusions- og eksklusionskriterier er tilpasset de enkelte databaser. • Dubletter er så vidt muligt frasorteret ved hjælp af RefWorks. De fundne referencer overføres til Covidence (referenceværktøj) • Fuldtekster præsenteres i Covidence i pdf-format • Søgestrategi for hver enkelt database præsenteres – hvis muligt vises det eksplicit hvor mange referencer den enkelte søgestreng genererer 2 SØGESTRATEGI Søgning efter primærlitteratur (RCT) PICO 1: Bør behandling med demenslægemidler seponeres hos personer med meget svær demens? Søgt 05.03.2018 Medline Database(s): Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, Ovid MEDLINE and Versions(R) 1946 to March 07 2018 Search Strategy: # Searches Results 1 Dementia/ 44270 2 exp Alzheimer Disease/ 81741 3 exp Aphasia, Primary Progressive/ 649 4 exp Primary Progressive Nonfluent Aphasia/ 95 5 exp Dementia, Vascular/ 6083 6 exp Dementia, Multi-Infarct/ 1083 7 exp Frontotemporal Lobar Degeneration/ 3378 8 exp Frontotemporal Dementia/ 2424 9 exp Lewy Body Disease/ 2711 10 (dementia* or alzheimer* or (Primary adj3 Progressi* adj3 aphasia) or (Frontotemporal adj3 187870 (Degeneration or neurodegeneration)) or lewy-body or lewy-bodies or (lewy adj2 (body or bodies)) or (Parkinson* adj4 dementia) or BPSD or PDD or FTD or DLB).ti,ab,kw,kf. 11 or/1-10 206411 12 exp Acetylcholinesterase/ 20580 13 Cholinesterase Inhibitors/ 19207 14 (Acetylcholinesterase* or Acetylcholine Hydrolase or Acetylthiocholinesterase* or AChEI or 28668 Cholinesterase Inhibitor*).ti,ab,kw,kf. 15 (NMDA adj2 antagonist*).ti,ab,kw,kf. 11498 16 Memantine/ 2008 17 Rivastigmine/ 1033 18 Galantamine/ 1451 19 (Donepezil* or Memantin* or Rivastigmin* or Galantamin*).ti,ab,kw,kf. 7070 20 or/12-19 58162 3 21 exp Withholding treatment/ 14037 22 Substance Withdrawal Syndrome/ 20348 23 Deprescriptions/ 126 24 (discontinu* or deprescrib* or deprescrip* or withdraw* or with-draw* or taper* or 293448 cessat*).ti,ab,kw,kf. 25 ((withhold* or with-hold* or withheld* or with-held* or stop* or pause* or end*3) adj4 65369 (treat* or therap* or prescrib* or prescription* or drug* or medication* or medicine)).ti,ab,kw,kf. 26 or/21-25 366052 27 11 and 20 and 26 544 28 limit 27 to (randomized controlled trial or controlled clinical trial) 125 29 (((random* or cluster-random* or control?ed or crossover or cross-over or blind* or mask*) 586309 adj4 (trial*1 or study or studies or analy*)) or rct).ti,ab,kw,kf. 30 (placebo* or single-blind* or double-blind* or triple-blind*).ti,ab. 252245 31 ((single or double or triple) adj2 (blind* or mask*)).ti,ab. 155727 32 ((patient* or person* or participant* or population) adj3 (random* or blind* or mask*)).ti,ab. 125306 33 or/29-32 714010 34 27 and 33 224 35 28 or 34 238 36 limit 35 to (danish or english or german or norwegian or swedish) 231 37 limit 36 to (systematic reviews or meta analysis) 53 38 36 not 37 177 Embase Database(s): Embase 1974 to 2018 March 02 Search Strategy: # Searches Results 1 Dementia/ 102210 2 exp Alzheimer Disease/ 167894 3 exp primary progressive aphasia/ 2968 4 exp Primary Progressive Nonfluent Aphasia/ 660 5 exp frontotemporal dementia/ 14224 6 exp Multiinfarct Dementia/ 10848 7 exp Frontotemporal Lobar Degeneration/ 14224 8 exp pick presenile dementia/ 1264 9 exp diffuse lewy body disease/ 6930 10 mental deterioration/ 5124 11 exp presenile dementia/ 656 12 exp senile dementia/ 3459 4 13 exp "mixed depression and dementia"/ 120 14 (dementia* or alzheimer* or (Primary adj3 Progressi* adj3 aphasia) or (Frontotemporal 265089 adj3 (Degeneration or neurodegeneration)) or lewy-body or lewy-bodies or (lewy adj2 (body or bodies)) or (Parkinson* adj4 dementia) or BPSD or PDD or FTD or DLB).ti,ab,kw. 15 14 and (2016* or 2017* or 2018*).em. 59828 16 or/1-13,15 275853 17 exp cholinesterase inhibitor/ 82646 18 (Acetylcholinesterase* or Acetylcholine Hydrolase or Acetylthiocholinesterase* or AChEI or 39563 cholinesterase block* or choline esterase inhibitor* or ((acetylcholinesteras* or cholinesteras*) adj2 inhibit*) or (anti adj cholinesteras*) or anticholinesteras* or CHEI).ti,ab,kw. 19 (NMDA adj2 antagonist*).ti,ab,kw. 14183 20 (Donepezil* or Memantin* or Rivastigmin* or Galantamin*).ti,ab,kw. 10775 21 or/17-20 117769 22 exp withdrawal syndrome/ or exp treatment withdrawal/ or drug withdrawal/ 32455 23 exp Deprescription/ 128 24 (discontinu* or deprescrib* or deprescrip* or withdraw* or with-draw* or taper* or 410919 cessat*).ti,ab,kw. 25 ((withhold* or with-hold* or withheld or with-held* or stop* or pause* or end*3) adj4 103269 (treat* or therap* or prescrib* or prescription* or drug* or medication* or medicine)).ti,ab,kw. 26 or/22-25 513283 27 16 and 21 and 26 1095 28 limit 27 to (randomized controlled trial or controlled clinical trial) 212 29 (((random* or cluster-random* or control?ed or crossover or cross-over or blind* or mask*) 803980 adj4 (trial*1 or study or studies or analy*)) or rct).ti,ab,kw. 30 (placebo* or single-blind* or double-blind* or triple-blind*).ti,ab. 348569 31 ((single or double or triple) adj2 (blind* or mask*)).ti,ab. 211217 32 ((patient* or person* or participant* or population) adj3 (random* or blind* or 184992 mask*)).ti,ab. 33 or/29-32 983501 34 27 and 33 403 35 28 or 34 445 36 limit 35 to (danish or english or german or norwegian or swedish) 434 37 limit 36 to ("systematic review" or meta analysis or letter or note) 61 38 36 not 37 373 5 PsycINFO Database(s): PsycINFO 1806 to February Week 4 2018 Search Strategy: # Searches Results 1 exp Dementia/ 68719 2 exp Neurodegenerative Diseases/ 69745 3 (dementia* or alzheimer* or (Primary adj3 Progressi* adj3 aphasia) or (Frontotemporal 118181 adj3 (Degeneration or neurodegeneration)) or lewy-body or lewy-bodies or (lewy adj2 (body or bodies)) or (Parkinson* adj4 dementia) or BPSD or PDD or FTD or DLB).ti,ab,id. 4 or/1-3 139923 5 exp Cholinesterase Inhibitors/ 2389 6 (AChEI or cholinesterase block* or choline esterase inhibitor* or acetylcholinesterase 3129 inhibit* or cholinesterase inhibit* or anti cholinesterase* or anticholinesteras* or CHEI).ti,ab,id. 7 (NMDA adj2 antagonist*).ti,ab,id. 3913 8 (Donepezil* or Memantin* or Rivastigmin* or Galantamin*).ti,ab,id. 3199 9 or/5-8 9183 10 (discontinu* or deprescrib* or deprescrip* or withdraw* or with-draw* or taper* or 72555 cessat*).ti,ab,id. 11 ((withhold* or with-hold* or withheld* or with-held* or stop* or pause* or end*3) adj4 10197 (treat* or therap* or prescrib* or prescription* or drug* or medication* or medicine)).ti,ab,id. 12 or/10-11 81396 13 4 and 9 and 12 342 14 (((random* or cluster-random* or control?ed or crossover or cross-over or blind* or mask*) 90603 adj4 (trial*1 or study or studies or analy*)) or rct).ti,ab,id. 15 (placebo* or single-blind* or double-blind* or triple-blind* or ((single or double or triple) 45200 adj2 (blind* or mask*))).ti,ab,id. 16 ((patient* or person* or participant* or population) adj3 (random* or blind* or 19985 mask*)).ti,ab. 17 or/14-16 122066 18 13 and 17 122 19 limit 18 to (danish or english or german or norwegian or swedish) 121 20 limit 19 to ("0830 systematic review" or 1200 meta analysis) 14 21 19 not 20 107 6 PICO 2: Bør personer med demens i langvarig behandling med antipsykotisk medicin revurderes med henblik på om behandlingen skal fortsætte eller seponeres? Søgt 12.02.2018 Medline Database(s): Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, Ovid MEDLINE and Versions(R) 1946 to February 07, 2018 Search Strategy: # Searches Results 1 Dementia/ 43949 2 exp Alzheimer Disease/ 81147 3 exp Aphasia, Primary Progressive/ 639 4 exp Primary Progressive Nonfluent Aphasia/ 94 5 exp Dementia, Vascular/ 6067 6 exp Dementia, Multi-Infarct/ 1082 7 exp Frontotemporal Lobar Degeneration/ 3318 8 exp Frontotemporal Dementia/ 2374 9 exp Lewy Body Disease/ 2684 10 (dementia* or alzheimer* or (Primary adj3 Progressi* adj3 aphasia) or (Frontotemporal adj3 186863 (Degeneration or neurodegeneration)) or lewy-body or lewy-bodies or (lewy adj2 (body or bodies)) or (Parkinson* adj4 dementia) or BPSD or PDD or FTD or DLB).ti,ab,kw,kf.