Table 1.
Practice Guidelines for ChEI Discontinuation
| Reference (Year) |
Country | No Recom menda tion |
Recom- mend to Not Discontinue |
Discontinue Based On: | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
|
| |||||||||||
| Lack of Respons e/Loss of Effective ness |
Side Effects / Adverse Events |
Severity of Cognitive Impairme nt |
Functional Level / Stage |
Institutio nail- zation |
Behavior | Medical Status |
Family/ CG/ Patient Preferenc e |
||||
| AAFP (2011)(32) | USA | X ‡ⱶ | |||||||||
| ACP & AAFP (2008)(25) | USA | X | |||||||||
| AGS (2014, 2015)(20, 22) | USA | X †§ | X § | ||||||||
| APA (2014)(21) | USA | X | |||||||||
| BAP (2017)(45) | UK | X †§ | |||||||||
| BPS & RCPsych (2007)(33) | UK | X §ⱶ | X1 ⱶ | X §ⱶ | X §ⱶ | ||||||
| CCCDTD (2014)(29) | Canada | X § | X § | X2§ | X § | X § | |||||
| CWGAD (2011)(35) | USA | X §‡ | |||||||||
| EFNS (2010)(27) | Multinational (Europe) | X †§ | |||||||||
| IAP (2005)(28) | Italy | X †§ | |||||||||
| MoH (2013)(30) | Singapore | X § | X § | ||||||||
| NICE (2016)(34) | UK | X †‡§ | X3 †‡§ | ||||||||
| PHN (2016)(23) | Australia | X †‡§ | X †‡§ | X †‡§ | |||||||
| RNAO (2016)(26) | Canada | X | |||||||||
| WFSBP (2011)(31) | Multinational | X § | X § | ||||||||
AAFP = American Academy of Family Physicians; ACP = American College of Physicians; APA = American Psychiatric Association; BAP = British Association for Psychopharmacology; BPS = British Psychological Society; CCCDTD = Canadian Consensus Conference on the Diagnosis and Treatment of Dementia; CWGAD = California Workgroup on Guidelines for Alzheimer’s Disease management; EFNS = European Federation of Neurological Societies; IAP = Italian Association of Psychogeriatrics; MoH = Singapore Ministry of Health; NICE = National Institute for Health and Care Excellence; PHN = Primary Health Tasmania; RCP = Royal College of Physicians; RCPsych = Royal College of Psychiatrists; RNAO = Registered Nurses’ Association of Ontario; WFSBP = World Federation of Societies of Biological Psychiatry
ChEI discontinuation indicated when Mini Mental State Examination (MMSE score < 10)
ChEI discontinuation indicated when dementia progresses to a stage (e.g., Global Deterioration Scale stage 7) where no benefit is expected from continued pharmacotherapy.
ChEI discontinuation indicated using clinical judgement of AD severity rather than rigid adherence to MMSE alone
Evidence from randomized, controlled trial.
Evidence from general review of scientific literature and industry reports.
Evidence from expert consensus/clinical expertise.
Evidence from another guideline.