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Discontinuing cholinesterase inhibitors: results of a survey of Canadian dementia experts

Published online by Cambridge University Press:  20 September 2010

Nathan Herrmann ,
Sandra E. Black ,
Abby Li  and
Krista L. Lanctôt
Nathan Herrmann*
Affiliation:
Department of Psychiatry and Faculty of Medicine, University of Toronto, and Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Sandra E. Black
Affiliation:
Division of Neurology, Department of Medicine, University of Toronto, and Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Abby Li
Affiliation:
Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Krista L. Lanctôt
Affiliation:
Department of Psychiatry, University of Toronto, and Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
*
Correspondence should be addressed to: Dr. Nathan Herrmann, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. Phone: +1 416-480-6133; Fax: +1 416-480-6022. Email: n.herrmann@utoronto.ca.
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Abstract

Background: Cholinesterase inhibitors (ChEIs) are being used for increasingly long periods of time, even in patients with severe Alzheimer's disease. Because there is little data to help clinicians to decide on when it is safe and appropriate to discontinue ChEIs after long-term use, practices may vary widely.

Methods: An internet-based survey was undertaken of Canadian dementia experts (geriatric psychiatrists, neurologists, geriatricians) involved in clinical trial research. Recommendations for ChEI discontinuation were determined based on responses to questions dealing with patient/caregiver preference, administrative considerations, effectiveness, and adverse events.

Results: There was reasonable consensus that ChEIs should be discontinued based on patient and caregiver preference, and in the presence of severe bothersome adverse events. There was much less consensus on issues related to effectiveness – in particular, what constitutes greater than expected decline. There was a general reluctance to rely on any single measure of cognition, function and/or behavior, and in particular, the MMSE was seen as unhelpful for making decisions about discontinuation.

Conclusion: Recommendations for discontinuing ChEIs after long-term use from a survey of dementia experts are presented. Ideally, clinical practice guidelines based on controlled discontinuation trials are needed.

Keywords

cholinesterase inhibitorsAlzheimer's diseasedementiatreatment
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 4 , May 2011 , pp. 539 - 545
Copyright
Copyright © International Psychogeriatric Association 2010

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