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National Collaborating Centre for Mental Health (UK). Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care. Leicester (UK): British Psychological Society; 2007. (NICE Clinical Guidelines, No. 42.)

12. GLOSSARY

Acetylcholinesterase inhibitors

Drugs that prevent the breakdown of acetylcholine, a neurotransmitter thought to be important in the chemical basis of a number of cognitive processes, including memory, thought and judgement. Acetylcholinesterase inhibitors used in clinical practice include rivastigmine, donepezil and galantamine.

Activities of daily living

Everyday parts of normal life, for example, shopping, maintaining a home and personal care, mobility, toileting and language skills.

Adverse event

Any undesirable experience that results from the administration of a pharmacologically active agent, and regarded to be a serious adverse event if it results in any of the following outcomes: death, a life-threatening experience, inpatient hospitalisation or prolongation of existing hospitalisation, a persistent or significant disability/incapacity, or a congenital anomaly/birth defect.

Alzheimer’s disease

A disease usually characterised by loss of memory, especially for learning new information, reflecting deterioration in the functioning of the medial temporal lobe and hippocampus areas of the brain. Later in the illness, other higher functions of the cerebral cortex become affected: these include language, praxis (putting theoretical knowledge into practice) and executive function (involved in processes such as planning, abstract thinking, rule acquisition, initiating appropriate actions and inhibiting inappropriate actions, and selecting relevant sensory information). Behavioural and psychiatric disturbances are also seen, which include depression, apathy, agitation, disinhibition, psychosis (delusions and hallucinations), wandering, aggression, incontinence and altered eating habits.

Alzheimer’s Disease and Related Disorders Association

The former title of the Alzheimer’s Association, a US voluntary health organisation dedicated to finding prevention methods, treatments and an eventual cure for Alzheimer’s disease. Its aim is the advancement of research to provide and enhance care and support for those affected and to reduce the risk of dementia through the promotion of brain health.

Animal-assisted therapy

The use of trained animals in facilitating patients’ progress toward therapeutic goals (Barker & Dawson, 1998).

Anxiolytics

Drugs used to alleviate anxiety states.

Antipsychotics

This group of medicines acts on a brain chemical, dopamine. Their main use is in psychotic illness, but their dopamine-blocking properties can help, when used together with other medicines, in some people with OCD, especially those who do not respond to standard treatments.

Asthenia

Lack or loss of strength; weakness.

Behavioural and psychological symptoms of dementia

A term used to describe the behavioural and psychiatric disturbances often seen in later stages of dementia. Symptoms commonly include depression, apathy, agitation, disinhibition, psychosis (delusions and hallucinations), wandering, aggression, incontinence and altered eating habits.

Cardiopulmonary resuscitation

An emergency first-aid procedure administered to a person who has suffered a cardiac arrest (that is, an unconscious person in whom neither breathing nor pulse can be detected). It consists of giving rescue breaths (mouth-to-mouth breathing) and chest compressions. In some cases, this can restart the heart and breathing, but more commonly it allows sufficient blood to circulate to lengthen the time before organ damage occurs.

Care management

An alternative term for the care programme approach.

Case management

A term referring to the application of the care programme approach to the management of chronic diseases.

Care programme approach (CPA)

Introduced in 1991, this approach was designed to ensure that different community services are coordinated and work together towards an individual’s care. It requires that professionals from the health authority and local authority arrange care collaboratively, and it applies to all patients accepted for care by the specialist mental health services.

Case series

A study of the treatment of a number of people that is normally evaluated with standardised instruments at different times, such as before treatment, after treatment and at follow-up some time after treatment. Unlike controlled trials or cohort studies, there is usually no control or comparison group. Although useful in early studies of new treatments, case series are not considered to be a rigorous test of a treatment.

Case study

A detailed description of the treatment of a single individual. Such studies may have an important role in the development of new treatments but do not generally allow strong conclusions to be made about effectiveness.

Cerebrospinal fluid

A nutrient-rich fluid, continuously being produced and absorbed, which flows in the ventricles (cavities) within the brain and around the surface of the brain and spinal cord.

Committee on Safety of Medicines

One of the independent advisory committees established under the Medicines Act (Section 4) that advises the UK Licensing Authority on the quality, efficacy and safety of medicines in order to ensure that appropriate public health standards are met and maintained. On 30 October 2005, the Commission on Human Medicines was established, which combines the functions of the Committee on Safety of Medicines and the Medicines Commission.

Consortium to Establish a Registry for Alzheimer’s Disease

A US group established in 1986 by a grant from the National Institute on Aging to standardise procedures for the evaluation and diagnosis of patients with Alzheimer’s disease.

Cognitive behavioural therapies

A range of behavioural and cognitive behavioural therapies, in part derived from the cognitive behavioural model of affective disorders, in which the patient works collaboratively with a therapist using a shared formulation to achieve specific treatment goals. Such goals may include recognising the impact of behavioural and/or thinking patterns on feeling states and encouraging alternative cognitive and/or behavioural coping skills to reduce the severity of target symptoms and problems.

Cognitive rehabilitation

Individually tailored intervention, working on personal goals, often using external cognitive aids and some use of learning strategies.

Cognitive stimulation (reality orientation)

Exposure to and engagement with activities and materials involving some degree of cognitive processing, usually within a social context. The intervention is often group-based, with the emphasis on enjoyment of activities.

Cognitive stimulation therapy

A brief group-based treatment for people with mild to moderate dementia, which involves 14 sessions of themed activities (physical games, sound, childhood, food, current affairs, faces/scenes, word association, being creative, categorising objects, orientation, using money, number games, word games and a team quiz), running over a 7-week period. Sessions aim to actively stimulate and engage people with dementia, whilst providing an optimal learning environment and the social benefits of a group therapy.

Cognitive training

Involves training exercises geared to specific cognitive functions, and practice and repetition of these exercises. It may be computer assisted, and individual or group based.

Cohort study (also known as follow-up, incidence, longitudinal or prospective study)

An observational study in which a defined group of people (the cohort) is followed over time. Outcomes are compared in subsets of the cohort who were exposed or not exposed (or exposed at different levels) to an intervention or other factor of interest.

Comorbidity

Two or more diseases or conditions occurring at the same time, such as depression and anxiety.

Computed tomography

A medical imaging method (that is, evaluation of an area of the patient’s body that is not externally visible) employing tomography (imaging by sections). A three-dimensional image of the area is generated from a large series of two-dimensional x-ray images taken around a single axis of rotation.

Confidence interval

The range within which the ‘true’ values (for example, size of effect of an intervention) are expected to lie with a given degree of certainty (for example, 95% or 99%). (Note: confidence intervals represent the probability of random errors, but not systematic errors or bias.)

Cost-effectiveness analysis

A type of full economic evaluation that compares competing alternatives of which the costs and consequences vary. The outcomes are measured in the same non-monetary (natural) unit. It expresses the result in the form of an incremental (or average or marginal) cost-effectiveness ratio.

Costs (direct)

The costs of all the goods, services and other resources that are consumed in the provision of a health intervention. They can be medical or non-medical.

Costs (indirect)

The lost productivity suffered by the national economy as a result of an employee’s absence from the workplace through illness, decreased efficiency or premature death.

Counselling

In its broadest sense, refers to a psychological therapy that allows people to explore their symptoms and problems with a trained individual. The emphasis is on enabling the subject to help him/herself and does not involve giving advice or directing him/her to take specific actions. It is usually delivered on an individual basis, although it can also be delivered in groups. The term counselling is sometimes used interchangeably with a number of specific psychological therapies.

Creative arts therapy

Intentional usage of the creative arts as a form of therapy (for example, dance therapy, music therapy and drama therapy).

Creutzfeldt-Jakob disease

A rapidly progressing disease of the nervous system, which causes deterioration of brain tissue. There are several forms of the disease, the most common of which is sporadic CJD, which currently has no identifiable cause and which affects mostly middle-aged or elderly people.

Dementia care mapping

An observation tool designed to examine quality of care from the perspective of the person with dementia, it is part of a process of bringing about improvements to care and is designed to be used only in formal care settings. It is grounded in the philosophy of person-centred care, which promotes the personhood of people with dementia and a holistic approach to their care. The dementia care mapping process involves briefing staff who work in the area to be ‘mapped’ about the method, observation of participants with dementia within the setting for at least 6 hours, processing the analysed data, feeding back this information to staff and using it to create an action plan for change in the setting. Therefore, it is a means for bringing about change and improvements based on direct observations of the care being delivered (www.bradford.ac.uk/acad/health/bdg/dcm/index.php).

Dementia with Lewy bodies

One of the most common types of progressive dementia and shares characteristics with both Alzheimer’s and Parkinson’s diseases. Its central feature is progressive cognitive decline, combined with three additional defining features: pronounced fluctuations in alertness and attention, such as frequent drowsiness, lethargy, lengthy periods of time spent staring into space or disorganised speech; recurrent visual hallucinations; and parkinsonian motor symptoms, such as rigidity and the loss of spontaneous movement. The symptoms of DLB are caused by the build-up of Lewy bodies (protein deposits found in nerve cells) in areas of the brain that control particular aspects of memory and motor control.

Detection bias

Systematic differences between the comparison groups in outcome assessment.

Double blind (also termed double masked)

A trial in which neither the participants nor the investigators (outcome assessors) are aware of which intervention the participants are given. The purpose of blinding the participants (recipients and providers of care) is to prevent performance bias. The purpose of blinding the investigators (outcome assessors) is to protect against detection bias.

Economic evaluation

Technique developed to assess both costs and consequences of alternative health strategies and to provide a decision-making framework.

Effect size

An estimate of the size of the effect that a given treatment has compared with a control treatment (for example, another active treatment, no treatment or ‘treatment as usual’). Examples of effect sizes are the relative risk statistic (used for dichotomous outcomes), and the weighted mean difference and standardised mean difference statistics (both used for continuous outcomes).

Effectiveness

The extent to which a specific intervention, when used under ordinary circumstances, does what it is intended to do. Clinical trials that assess effectiveness are sometimes called management trials.

Efficacy

The extent to which an intervention produces a beneficial result under ideal conditions. Clinical trials that assess efficacy are sometimes called explanatory trials and are restricted to participants who fully cooperate. The randomised controlled trial is the accepted ‘gold standard’ for evaluating the efficacy of an intervention.

Electroencephalogram

A non-invasive, diagnostic technique that records the electrical impulses produced by brain-cell activity via electrodes attached to the scalp. An EEG reveals characteristic brain-wave patterns that may assist in the diagnosis of neurological conditions, such as seizure disorders, impaired consciousness, and brain lesions or tumours.

Emotion-oriented care

Care aimed at improving emotional and social functioning and the quality of life of people with dementia.

Fluoro-2-deoxy-D-glucose

A compound used in positron emission tomography (PET) that binds to a radioactive tracer isotope (the agent detected by the imaging scanner) and which, upon injection into the body, facilitates the tracer’s passage through the blood flow into the tissues of interest in the body.

Frontotemporal dementia

A type of dementia associated with shrinking of the frontal and temporal anterior lobes of the brain. The symptoms of FTD fall into two clinical patterns that involve either changes in behaviour or problems with language. Spatial skills and memory remain intact. There is a strong genetic component to the disease and it often runs in families.

Forest plot

A graphical display of results from individual studies on a common scale, allowing visual comparison of trial results and examination of the degree of heterogeneity between studies.

General Medical Council

A body that registers doctors to practise medicine in the UK. Its purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.

Genetic counselling

Providing an assessment of heritable risk factors and information to individuals and their relatives concerning the consequences of a disorder, the chance of developing or transmitting it, how to cope with it, and ways in which it can be prevented, treated and managed.

Guideline development group

The group of academic experts, clinicians and patients responsible for developing the guideline.

Guideline implementation

Any intervention designed to support the implementation of guideline recommendations.

Guideline recommendation

A systematically developed statement that is derived from the best available research evidence, using predetermined and systematic methods to identify and evaluate evidence relating to the specific condition in question.

Guideline Review Panel

A panel that contributes to the guideline development process by providing external validation for the guidelines, mainly by ensuring stakeholders’ comments on the drafts of the scope and guideline are addressed and that the final recommendations can be implemented.

Health Technology Appraisal

The process of determining the clinical and cost effectiveness of a health technology in order to develop recommendations on the use of new and existing medicines and other treatments within the NHS in England and Wales.

Healthcare professional

A generic term used in this guideline to cover all health professionals such as GPs, psychologists, psychotherapists, psychiatrists, paediatricians, nurses, health visitors, counsellors, art therapists, music therapists, drama therapists, occupational therapists.

Heterogeneity

A term used to illustrate the variability or differences between studies in the estimates of effects.

Hexamethylpropyleneamine oxime

A compound used in single-photon emission computed tomography (SPECT) brain scanning that binds to a gamma-emitting tracer (the agent detected by the nuclear gamma camera in the scanning process) and which, upon injection into the body, facilitates the tracer’s passage through the blood flow into the brain.

Homogeneity

A term used to illustrate when there are no, or minor, variations in the directions and degrees of results between individual studies that are included in the systematic review.

Incremental cost-effectiveness ratio

The difference in the mean costs in the population of interest divided by the differences in the main outcomes in the population of interest.

Iodine I 123-radiolabeled 2beta-carbomethoxy-3beta-(4-iodophenyl)-N-(3_fluo-ropropyl) nortropane

A form of single-photon emission computed tomography (SPECT), FP-CIT is licensed for the investigation of suspected parkin-sonism and shows high sensitivity and specificity in separating cases of Parkinson’s disease from disorders such as essential tremor.

Key questions

Questions posed by the Guideline Development Group, which are used to guide the identification and interrogation of the evidence base relevant to the topic of the guideline.

Life review

A naturally occurring process where the person looks back on their life and reflects on past experiences, including unresolved difficulties and conflicts. This concept was incorporated in a psychotherapy for older people, which emphasises that life review can be helpful in promoting a sense of integrity and adjustment. Life--review therapy has its roots in psychotherapy, involving evaluation of personal (sometimes painful) memories with a therapeutic listener, usually in a one-to-one setting. (Woods et al., in press).

Magnetic resonance imaging

A form of medical imaging used to visualise and evaluate an area of the patient’s body that is not externally visible. It uses radio frequency signals and a magnet to acquire its images and is best suited to soft tissue examinations. In clinical practice, MRI is used to distinguish pathological tissue (such as a brain tumour) from normal tissue.

Medical Research Council

A national organisation funded by the UK taxpayer. It promotes research into all areas of medical and related science with the aim of improving the health and quality of life of the public.

Medicines and Healthcare products Regulatory Agency

The UK licensing authority (a government agency) that is responsible for ensuring that medicines and medical devices work and are acceptably safe.

Memantine hydrochloride

a moderate-affinity uncompetitive NMDA-receptor antagonist licensed in the UK for treating moderate to severe Alzheimer’s disease. It works by regulating glutamate, a chemical involved in information processing, storage and retrieval.

Meta-analysis

The use of statistical techniques in a systematic review to integrate the results of several independent studies.

Mild cognitive impairment

An isolated cognitive impairment(s) (a reduction in the ability to think, concentrate, formulate ideas, reason and remember) identified as abnormal by a statistical rule and representing a decline from previous level of function. The cognitive impairment should not be so severe as to affect social or occupational functioning (at which point the diagnosis of dementia would be more appropriate).

Multidisciplinary

For the purposes of this guideline, this term refers to professionals who are involved in the care of people with dementia working in partnership across disciplines or fields of expertise.

National Collaborating Centre for Mental Health

One of seven centres established by the National Institute for Health and Clinical Excellence (NICE) to develop guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS in England and Wales. Established in 2001, the NCCMH is responsible for developing mental health guidelines, and is a partnership between the Royal College of Psychiatrists and the British Psychological Society.

National Institute for Health and Clinical Excellence

An independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. It provides guidance on three areas of health: public health, health technologies and clinical practice.

National Institute of Neurological Disorders and Stroke

An organisation affiliated to the National Institutes of Health (an agency of the Public Health Service within the US) that supports and conducts biomedical research on disorders of the brain and nervous system.

National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l’Enseignement en Neurosciences

An international workshop convened by the neuroepidemiology branch of the National Institute of Neurological Disorders and Stroke and supported by the Association Internationale pour la Recherche et l’Enseignement en Neurosciences with the aim of drawing up criteria for the diagnosis of vascular dementia.

N-methyl-D-aspartate

A water-soluble synthetic substance that mimics the action of the neurotransmitter glutamate on the NMDA receptor. In contrast to glutamate, NMDA binds to and opens the NMDA receptor only, and not other glutamate receptors.

Non-cognitive symptoms

Symptoms often experienced by people with dementia that are sometimes described as neuropsychiatric symptoms or ‘behavioural and psychological symptoms of dementia’ (BPSD), which include delusions, hallucinations, depression, anxiety, apathy and a range of behaviours, such as aggression, wandering, disinhibition and agitation.

Non-steroidal anti-inflammatory drugs

Drugs with analgesic, antipyretic and anti-inflammatory effects (that is, they reduce pain, fever and inflammation). The term ‘non-steroidal’ is used to distinguish them from glucocortoids (a type of steroid also used to reduce inflammatory conditions).

Number needed to treat for benefit

In a trial comparing a new treatment with a standard one, the number needed to treat for benefit is the estimated number of participants who need to be treated with the new treatment rather than the standard treatment for one additional participant to benefit. The lower the number needed to benefit, the higher the likelihood of benefit.

Number needed to treat for harm

In a trial comparing a new treatment with a standard one, the number needed to treat for harm is the estimated number of participants who need to be treated with the new treatment rather than the standard treatment for one additional participant to be harmed. The lower the number needed to harm, the higher the likelihood of harm.

Performance bias

Systematic differences in the care provided to the participants in the comparison groups other than the intervention under investigation.

Peripheral oedema

An observable swelling in the feet and legs resulting from the accumulation of excess fluid in interstitial spaces (spaces within the tissues that are outside of the blood vessels) under the skin.

Placebo

A non-drug, or physically inactive substance (sugar, distilled water or saline solution), which is given as part of a clinical research trial. It has no specific pharmacological activity against illness.

Positron emission tomography

Positron emission tomography is a nuclear medicine (medicine in which radioactive substances are administered to the patient) medical imaging technique which produces a three-dimensional image or map of functional processes in the body. It is commonly used in the diagnosis of dementias.

Psychoeducation

Programmes for individuals or groups of people that involve an explicitly described educational interaction between the intervention provider and the recipient as the prime focus of the study.

Psychological therapies

A group of treatment methods that involve psychosocial rather than physical intervention. They include cognitive behavioural therapy, family therapy, systemic family therapy, non-directive supportive therapy, psychodynamic psychotherapy, group psychotherapy, counselling, art therapy, interpersonal psychotherapy, guided self-help and any other form of therapy that aims to be helpful through the communication of thoughts and feelings in the presence of a therapist, who works with the material using a systematic framework for understanding and responding to it.

Psychosis

A condition in which an individual is not in contact with reality. This can include sensing things that are not really there (hallucinations), having beliefs that are not based on reality (delusions), problems in thinking clearly and not realising that there is anything wrong (called ‘lack of insight’).

Psychosocial

Involving aspects of social and psychological behaviour.

Quality adjusted life year

A form of utility measure calculated by estimating the total life years gained from a treatment and weighting each year with a quality-of-life score in that year.

Quality of life

Used in some treatment studies to show improvement in a person’s condition beyond reduction in symptoms, measures of QoL can be defined broadly and include satisfaction, especially within important areas of one’s life, the level of functioning in different areas and the objective circumstances in which one lives. In many studies, however, QoL is defined narrowly as the level of functioning or degree of handicap, which is one important aspect but limited as a marker of quality.

Randomisation

A method used to generate a random allocation sequence, such as using tables of random numbers or computer-generated random sequences. The method of randomisation should be distinguished from concealment of allocation, because if the latter is inadequate, selection bias may occur despite the use of randomisation. For instance, a list of random numbers may be used to randomise participants, but if the list were open to the individuals responsible for recruiting and allocating participants, those individuals could influence the allocation process, either knowingly or unknowingly.

Randomised controlled trial

(also termed randomised clinical trial)

An experiment in which investigators randomly allocate eligible people into groups to receive or not to receive one or more interventions that are being compared. The results are assessed by comparing outcomes in the different groups. Through randomisation, the groups should be similar in all aspects, apart from the treatment they receive during the study.

Relative risk

(also known as risk ratio)

The ratio of risk in the intervention group to the risk in the control group. The risk (proportion, probability or rate) is the ratio of people with an event in a group to the total in the group. An RR of 1 indicates no difference between comparison groups. For undesirable outcomes, an RR that is less than 1 indicates that the intervention was effective in reducing the risk of that outcome.

Relaxation therapy

Relaxation therapy uses a variety of physical and mental techniques (for example, tensing and relaxing different muscle groups in turn, imagining peaceful scenes, and so on) to help people to reduce bodily and psychological tension in a systematic way, which they can practice at home and use when under stress. It can be used as a component of a treatment package (for example, behaviour therapy) or as a therapy in its own right.

Reminiscence

Involves the discussion of past activities, events and experiences, usually with the aid of tangible prompts (for example, photographs, household and other familiar items from the past, music and archive sound recordings). Reminiscence therapy in a group context has the aim of enhancing interaction in an enjoyable, engaging fashion. (Woods et al., 1992).

Resources for Enhancing Alzheimer’s Caregiver Health

An initiative of the US National Institute on Aging in which six centres collaborated to use common measures and procedures to evaluate interventions for family carers of people with Alzheimer’s disease. Interventions were developed and implemented independently at each site.

Scottish Intercollegiate Guidelines Network

A network formed in 1993 to improve the quality of healthcare for patients in Scotland by reducing variation in practice and outcome. This is achieved through the development and dissemination of national clinical guidelines containing recommendations for effective practice based on current evidence.

Selective serotonin reuptake inhibitors

A class of antidepressant medications that increase the level of serotonin (a neurotransmitter believed to influence mood) in the brain.

Sensitivity

Refers to the proportion of people with disease who have a positive test result.

Sensitivity analysis

Sensitivity analysis is a technique used in economic analysis or decision making to allow for uncertainty by testing whether plausible changes in the values of the main variables affect the results of the analysis.

Single-photon emission computed tomography

A nuclear medicine (medicine in which radioactive substances are administered to the patient) imaging technique using gamma rays, which provides three-dimensional information. This information is typically presented as cross-sectional slices through the patient, but can be reformatted or manipulated as required.

Snoezelen

Provides sensory stimuli to stimulate the primary senses of sight, hearing, touch, taste and smell through the use of lighting effects, tactile surfaces, massage, meditative music and the odour of relaxing essential oils. (Chung et al., 2002).

Social Care Institute for Excellence

An independent registered charity, launched in 2001 as part of a government drive to improve social care, governed by a board of trustees, whose role is to develop and promote knowledge about good practice in social care.

Specificity

Refers to the proportion of people without disease who have a negative test result.

Standard care

The usual care given to those suffering from acute psychiatric episodes in the area concerned.

Standard deviation

A statistical measure of variability in a population of individuals or in a set of data. Whilst the average measures the expected middle position of a group of numbers, the standard deviation is a way of expressing how different the numbers are from the average. The standard deviation is (approximately) the amount by which the average person’s score differs from the average of all scores.

Standard error

A statistical estimate of the population standard deviation based on the mean and standard deviation of one sample. Standard error is calculated by dividing the standard deviation of the sample by the square root of the number of subjects in the sample.

Standardised mean difference

In a meta-analysis, an SMD is a way of combining the results of studies that may have measured the same outcome in different ways, using different scales. Statistically, it is calculated by dividing the weighted average effect size by the pooled standard deviation. The SMD is expressed as a standard value with no units.

Statistical significance

A result is significant if it is unlikely to have occurred by chance, given that, in reality, the independent variable (the test condition being examined) has no effect. In practice, an effect size that is statistically significant is one where the probability of achieving the result by chance is less than 5% (that is, a p-value less than 0.05).

Systematic review

Research that summarises the evidence on a clearly formulated question according to a predefined protocol using systematic and explicit methods to identify, select and appraise relevant studies, and to extract, collate and report their findings. It may or may not use statistical meta-analysis.

Validation therapy

Based on the general principle of validation, the acceptance of the reality and personal truth of another’s experience, validation therapy incorporates a range of specific techniques. Validation, in this general sense, can be considered as a kind of philosophy of care. It is identified as providing a high degree of empathy and an attempt to understand a person’s entire frame of reference, however disturbed that might be. Important features of validation therapy are said to include: a means of classifying behaviours; provision of simple, practical techniques that help restore dignity; prevention of deterioration into a vegetative state; provision of an emphatic listener; respect and empathy for older adults with Alzheimer’s-type dementia, who are struggling to resolve unfinished business before they die; and acceptance of the person’s reality. These features are not, however, unique to validation. (Neal & Barton Wright, 2003).

Vascular dementia

A common form of dementia that results from narrowing and blockage of the arteries that supply blood to the brain.

Values-based medicine

An extension of evidence-based medicine, which demands that the appropriateness of clinical interventions be justified by the existence of high-quality evidence for their effectiveness. The value of the intervention is defined as the improvement the intervention confers in length and/or quality of life, taking into consideration the patient’s perception of the value of the intervention. The perceived value of the intervention is combined with the associated cost of the intervention to give a final cost utility.

Waitlist control

A term used in controlled trials when participants are allocated to a ‘waitlist’ condition. Outcome measures are taken from these participants at the end of the waiting period and compared with those from participants who received the treatment. The waitlist participants then receive the treatment.

Weighted mean difference

A method of meta-analysis used to combine measures on continuous scales (such as the ADAS-cog), where the mean, standard deviation and sample size in each group are known. The weight given to each study (for example, how much influence each study has on the overall results of the meta-analysis) is determined by the precision of its estimate of effect and, in the statistical software used by the NCCMH, is equal to the inverse of the variance. This method assumes that all of the trials have measured the outcome on the same scale.

Copyright © 2007, The British Psychological Society & The Royal College of Psychiatrists.

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Enquiries in this regard should be directed to the British Psychological Society.

Cover of Dementia
Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care.
NICE Clinical Guidelines, No. 42.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2007.

NICE (National Institute for Health and Care Excellence)

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