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The Quality Standards Subcommittee of the American Academy of Neurology has tackled the complex clinical issues of dementia—early detection, diagnosis, and management.1-3⇓⇓ For three papers in this issue, 21 respected authors screened 5,956 articles, reviewed 1,054 in detail, and came up with 43 recommendations. The literature review itself was a labor of Sisyphus—the moment it was completed it was outdated. As Robert Burns wrote, “The best laid schemes o’ mice and men/Gang aft a-gley;/And leave us naught but grief and pain/For promised joy.” Developers of clinical practice guidelines have the grief and pain of seeing their work outdated by the time it is published.
The practice parameter on the diagnosis of dementia2 highlights and updates the 1994 version.4 Much of the guidance is quite rightly about what not to do. However, clinicians need this to be balanced by positive, unambiguous indications of what can usefully be done, by whom, and under what circumstances. The advice, for …
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