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The inclusion of cognition in vascular risk factor clinical practice guidelines
Kenneth Rockwood1, Laura E Middleton, Paige K Moorhouse
1Department of Medicine, Dalhousie University, Halifax, NS, Canada. kenneth.rockwood@dal.ca
Insights
Clinical practice guidelines for vascular risk factors rarely consider cognitive impairment. Few guidelines mention cognition as an outcome or in relation to treatment compliance, despite its link to vascular health.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Vascular risk factors increase the likelihood of cognitive impairment and vascular disease.
- Cognitive impairment can impact patient adherence to treatment plans.
Purpose of the Study:
- To evaluate if clinical practice guidelines for vascular risk factors incorporate cognition.
- To determine if cognition is considered an outcome or related to treatment compliance.
Main Methods:
- Systematic review of guidelines from PubMed, EMBASE, and Cochrane Library.
- Inclusion criteria: guidelines targeting hypertension, high cholesterol, diabetes, or atrial fibrillation in adults, aimed at physicians, and published in English.
- Exclusion of duplicates, older versions, and single-outcome guidelines.
Main Results:
- Five of 20 included guidelines mentioned cognition.
- Four guidelines discussed potential cognitive treatment benefits; two noted cognition's impact on compliance.
- No guidelines adequately detailed cognitive impairment screening procedures.
Conclusions:
- A small fraction of vascular risk factor guidelines acknowledge cognition.
- Cognition is inadequately addressed as an adverse outcome or compliance factor in current guidelines.
- Improved integration of cognitive health into vascular risk management guidelines is warranted.
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.
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