The inclusion of cognition in vascular risk factor clinical practice guidelines

Abstract

Background

People with vascular risk factors are at increased risk for cognitive impairment as well as vascular disease. The objective of this study was to evaluate whether vascular risk factor clinical practice guidelines consider cognition as an outcome or in connection with treatment compliance.

Methods

Articles from PubMed, EMBASE, and the Cochrane Library were assessed by at least two reviewers and were included if: (1) Either hypertension, high cholesterol, diabetes, or atrial fibrillation was targeted; (2) The guideline was directed at physicians; (3) Adult patients (aged 19 years or older) were targeted; and (4) The guideline was published in English. Of 91 guidelines, most were excluded because they were duplicates, older versions, or focused on single outcomes.

Results

Of the 20 clinical practice guidelines that met inclusion criteria, five mentioned cognition. Of these five, four described potential treatment benefits but only two mentioned that cognition may affect compliance. No guidelines adequately described how to screen for cognitive impairment.

Conclusion

Despite evidence that links cognitive impairment to vascular risk factors, only a minority of clinical practice guidelines for the treatment of vascular risk factors consider cognition as either an adverse outcome or as a factor to consider in treatment.

Keywords:

• clinical practice guidelines
• evidence-based medicine
• vascular risk
• cognition
• target organ damage

Supplementary materials

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Funding and acknowledgements

Kenneth Rockwood is supported by the Dalhousie Medical Research Foundation as Kathryn Allen Weldon Professor of Alzheimer Disease Research. Laura Middleton receives support from a Canadian Institute of Health Research Fellowship. Paige King Moorhouse holds a Killam Graduate Prize from the Killam Trust. Sandra Black receives funds from the Canadian Institutes of Health Research, the Alzheimer Society of Canada, and the Heart and Stroke Foundation. Ingmar Skoog is supported by major grants from The Swedish Research Council, Swedish Council for Working Life and Social Research, Swedish Brain Power, and LUA/ALF from the Sahlgrenska University Hospital.

Disclosures

Within the past five years, Kenneth Rockwood has participated in the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, and served as a paid consultant to the Centers for Disease Control on the role of exercise in dementia prevention, and to Pfizer, Eisai, Elan/Wyeth, GlaxoSmithKline, Janssen-Ortho, Myriad, Numico and Novartis on dementia treatment. He is a consultant to a study of dementia treatment for Pfizer. Sandra Black has participated in guidelines for stroke and dementia and has, within the past five years, served as a paid consultant to Pfizer, Janssen-Ortho, Novartis, Lundbeck, Myriad Pharmaceuticals, Epix Pharmaceuticals, GlaxoSmith-Kline, Schering-Plough, Elan and Wyeth Pharmaceuticals. She has also received research funds from Novartis Pharmaceuticals, Myriad Pharmaceuticals, Eisai-Pfizer, Sanofi-Aventis, Boehringer Ingelheim, Novo Nordisk and AstraZeneca and speaker’s honoraria from Janssen-Ortho, Novartis Pharmaceutical, Lundbeck, Pfizer and Myriad Pharmaceuticals. Ingmar Skoog was co-chairman on the SCOPE study and received honoraria from AstraZeneca for this. Ingmar Skoog has also been on speakers’ bureaus for AstraZeneca, Lundbeck, Shire, Esai, Pfizer, Novartis, JansenCilag, Bayer, and Organon. None of the authors hold stocks in any pharmaceutical company. None of these sponsors had any input into the decision to write or the content of the paper.