-
Discontinuing cholinesterase inhibitors in patients with moderate to severe Alzheimer’s disease may lead to worsening of cognitive function and greater functional impairment as compared to continued therapy (Grade 2B). This must be balanced with the risk for known side-effects and drug costs if therapy continues. It is suggested that cholinesterase inhibitors be discontinued when:
The patient and/or their proxy decision-maker decide to stop after being appraised of the risks and benefits of continuation and discontinuation; The patient is sufficiently non-adherent with the medication that continued prescription of it would be useless, and it is not possible to establish a system for the administration of the medication to rectify the problem; The patient’s rate of cognitive, functional, and/or behavioural decline is greater on treatment compared to that prior to being treated; The patient experiences intolerable side effects that are definitely or probably related to the cholinesterase inhibitor; The comorbidities of the patient make continued use of the agent either unacceptably risky or futile (e.g., terminally ill); The patient’s dementia progresses to a stage (e.g., Global Deterioration Scale stage 7) where there would be no clinically meaningful benefit from continued therapy.
When a decision has been made to discontinue therapy because of a perceived lack of effectiveness, it is suggested that the dose be tapered before stopping the agent and that the patient be monitored over the next 1–3 months for evidence of an observable decline. If this occurs, it is suggested that consideration be given to reinstating therapy (Grade 2C).
|
