Rationale and Comments

Use of acetyl cholinesterase inhibitors in mild to moderate dementia or N-methyl-D-aspartate antagonists in moderate to severe dementia may help with BPSD but have not been shown to prolong life. Once an individual is institutionalized, review of the risks and benefits of the medications should be reviewed periodically and deprescribed when no longer demonstrating benefit to the patient. Acetyl cholinesterase inhibitors can worsen anorexia and N-methyl-D-aspartate receptor agonists are not indicated with severe renal insufficiency, both of which could be present in the older population.

Sponsoring Organizations

• Society for Post-Acute and Long-Term Care Medicine

Sources

• Expert consensus

Disciplines

• Geriatric Medicine
• Neurologic

References

• Tjia J, et al. Daily medication use in nursing home residents with advanced dementia. J Am Geriatr Soc. 2010;58(5):880-888.
  
• Pelosi AJ, et al. Role of cholinesterase inhibitors in dementia care needs rethinking. BMJ. 2006;333(7566):491-493.
  
• Deardorff WJ, et al. The use of cholinesterase inhibitors across all stages of Alzheimer's disease. Drugs Aging. 2015;32(7):537-547.
  
• Palmer JB, et al. Use of drugs with anticholinergic properties among nursing home residents with dementia: a national analysis of Medicare beneficiaries from 2007 to 2008. Drugs Aging. 2015;32(1):79-86.
  
• Colloca G, et al.; SHELTER project. Inappropriate drugs in elderly patients with severe cognitive impairment: results from the shelter study. PLoS One. 2012;7(10):e46669.