Original Title: Protocoles médicaux nationaux et ordonnances associées: trouble neurocognitif , bilan sanguin

Authors' objectives: With the ageing population in Quebec, the prevalence of major neurocognitive disorders (NCD) will increase in the coming years. While there is as yet no pharmacological cure for this type of disease, early detection and diagnosis provide several advantages and allow patients to better assimilate information and make active preparations for their future with their family. Front-line health and social services professionals are often best at detecting mild or major NCDs. However, it seems that the complexity of the process leading to a diagnosis, combined with the lack of time and means, is the main obstacle to getting a diagnosis. The Act to amend the Professional Code (known as Bill 90) has made diagnosis of major NCDs easier by entitling certain professionals to undertake medical procedures otherwise reserved to doctors. However, some of these procedures are conditional on getting a prescription, be it collective or individual. Pursuant to a priority ranking exercise, and in the context of the implementation of the second phase of the ministerial initiative on Alzheimer and other major neurocognitive diseases, the INESSS was given the mandate to develop a National Medical Protocol (NMP) and a model of Collective Prescription (CP) for the establishment of a blood profile when suggestive symptoms and signs of a mild or major NCD are identified.

Authors' results and conclusions: RESULTS: Information retrieval efforts helped to glean 1,867 documents, of which only the report published by the INESSS in 2015 was selected. The use of structural neuroimaging for diagnosis in a context of front-line health care was excluded from this protocol. Only the measures necessary to establish blood profiles were retained. Research suggests that, prior to establishing the blood profile of a patient with suggestive symptoms and signs of a mild or major NCD, it is important to go beyond clinical suspicion and, therefore, perform a targeted clinical examination and objectively appraise any reported or suspected cognitive impairment. In the case of complaints associated to objectivized cognitive loss, all people aged 60 and above should undergo a series of blood tests – no matter what type of NCD is suspected and whether or not functional autonomy impairment is suspected –, to find the treatable causes, detect comorbidities likely to alter the patient’s cognitive functions, and eliminate any conditions likely to lead to medical misdiagnosis. A basic blood profile should be established in the early stage of the detection process and include the following tests: calcium and creatinine levels; electrolytes rates; a complete blood cell count; vitamin B12 levels; glycemia or glycated hemoglobin dosage; and thyroid function. Where required and depending on the clinical presumption, other tests can be requested. This research also helped to identify situations requiring special attention, reassessment or further investigation; these situations are defined in the model of CP as requiring the qualified professional to contact the authorized prescriber who attends the patient or to refer the patient for an emergency consultation. CONCLUSIONS: Elaborating a National Medical Protocol (NMP) for the establishment of blood profiles in a context of front-line care after detecting suggestive signs and symptoms of mild or major NCDs and the associated model of Collective Prescription (CP) is part of an action plan drawn up by the MSSS for the purpose of improving services and care for people with mild or major NCDs throughout Quebec. This work is based on clinical data and clinical practice recommendations drawn from literature, which were enhanced with the experiential knowledge of experts and clinicians and contextual information. With the insertion of knowledge stemming from various sources, this work allowed for the creation of clinical tools used to initiate a diagnostic process rapidly when there is clinical suspicion of cognitive decline. The pertinence of updating the NMP will be assessed at least every four years in order for the protocol to be revised within a five-year period.

Authors' methods: Since the INESSS completed research work on the detection of and the process leading to the diagnosis of Alzheimer and other major neurocognitive diseases in 2015, it was agreed to update the systematic review of the clinical practice guidelines, expert consensus statements, consensus conferences and other literature formulating clinical recommendations. The update had to be conducted in full compliance with the methodological standards of the INESSS. The literature research was narrowed to documents published between 2014 and 2019. A manual search of literature was also conducted on the websites of health technology assessment agencies, government organizations and professional associations concerned by the theme under study. CPs available within the health network and the clinical reference material were also consulted. A review of the bibliographies in selected literature was conducted to identify other relevant material. The analysis of the selected scientific data was carried out in a perspective of the context of practice, on the basis of elements of the legislative, regulatory and organizational context particular to Quebec and the experiential knowledge provided by the experts consulted.

Project Status: Completed

URL for protocol: https://www.inesss.qc.ca/thematiques/medicaments/protocoles-medicaux-nationaux-et-ordonnances-associees/troubles-neurocognitifs.html

Year Published: 2020

URL for published report: https://www.inesss.qc.ca/thematiques/medicaments/protocoles-medicaux-nationaux-et-ordonnances-associees/troubles-neurocognitifs.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: INESSS