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Discontinuation of cholinesterase inhibitor treatment in institutionalised patients with advanced dementia
  1. Ramón García-García1,2,
  2. Miguel Ángel Calleja-Hernández2,3
  1. 1Pharmacy, Hospital Universitario de Torrevieja, Torrevieja, Spain
  2. 2University of Granada, Granada, Spain
  3. 3Virgen Macarena University Hospital, Sevilla, Spain
  1. Correspondence to Dr Ramón García-García, Pharmacy, Hospital Universitario de Torrevieja, Torrevieja 03186, Spain; garciagaram{at}gmail.com

Abstract

Objective To evaluate the impact of discontinuation of treatment with cholinesterase inhibitors (ChEIs) on cognitive, behavioural and functional outcomes in patients with severe dementia.

Methods A prospective observational study in which the prescribing physician decides, depending on multidisciplinary assessment and following the recommendations of the clinical practice guidelines, whether to withdraw or continue ChEI treatment in institutionalised patients, with a follow-up of 3 months. Cognitive abilities were measured using the Mini-Mental State Examination (MMSE) and Reisberg’s Global Deterioration Scale (GDS). Other measures were the behavioural and psychological symptoms of dementia (BPSD) according to the Neuropsychiatric Inventory (NPI), the activities of daily living using the Barthel index, the pharmacological and the non-pharmacological measures to treat the BPSD.

Results ChEI treatment was discontinued in 23 of 43 patients. After 3 months there were no differences in MMSE (p=0.441), GDS (p=0.976), NPI (p=0.882) or Barthel index (p=0.080) scores, or the establishing of new pharmacological measures (p=0.919) or non-pharmacological measures (p=0.832).

Conclusions ChEI discontinuation in advanced stage dementia was not related to clinical deterioration in terms of cognitive function, BPSD, or functional status. Discontinuing ChEI treatment according to a multidisciplinary assessment and the recommendation of the guidelines appears to be a possible way of optimising pharmacotherapy without altering the main clinical evaluation scales.

  • clinical pharmacy
  • geriatric medicine
  • neurology
  • psychiatry
  • pharmacy management (personnel)
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