CCCDTD5 recommendations on the deprescribing of cognitive enhancers in dementia

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dc.contributor.authorHenri-Bhargava, Alexandre
dc.contributor.authorHerrmann, Nathan
dc.contributor.authorIsmail, Zahinoor
dc.contributor.authorCollins, Rhonda
dc.contributor.authorDesmarais, Philippe
dc.contributor.authorGoodarzi, Zahra
dc.contributor.authorIaboni, Andrea
dc.contributor.authorKirkham, Julia
dc.contributor.authorMassoud, Fadi
dc.contributor.authorMoser, Andrea
dc.contributor.authorSilvius, James
dc.contributor.authorWatt, Jennifer
dc.contributor.authorSeitz, Dallas
dc.date.accessioned2022-03-08T00:03:31Z
dc.date.available2022-03-08T00:03:31Z
dc.date.copyright2022en_US
dc.date.issued2022-01-31
dc.description.abstractIntroduction Cognitive enhancers (ie, cholinesterase inhibitors and memantine) can provide symptomatic benefit for some individuals with dementia; however, there are circumstances in which the risks of continuing treatment may potentially outweigh benefits. The decision to deprescribe cognitive enhancers must consider each patient's preferences, treatment indications, current clinical status and symptoms, prognosis, and dementia type. Methods The 5th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5) established a subcommittee of experts to review current evidence on the deprescribing of cognitive enhancers. The questions answered by this group included: When should cognitive enhancers be deprescribed in persons with dementia and mild cognitive impairment? How should cognitive enhancers be deprescribed? And, what clinical factors should be considered when deprescribing cognitive enhancers? Results Patient and care-partner preferences should be incorporated into all decisions to deprescribe cognitive enhancers. Cognitive enhancers should be discontinued in individuals without ongoing evidence of benefit or when the indication for cognitive enhancer use was inappropriate (eg, mild cognitive impairment). Deprescribing should occur gradually and cognitive enhancers should be reinitiated if patients’ cognition or function deteriorates. Cognitive enhancers should be continued in individuals whose neuropsychiatric symptoms improve in response to treatment. Clinicians should not deprescribe cognitive enhancers in individuals with significant neuropsychiatric symptoms until symptoms have stabilized. Conclusion CCCDTD5 deprescribing recommendations provide evidence-informed recommendations related to cognitive enhancer deprescribing that will facilitate shared decision making among patients, care partners, and clinicians.en_US
dc.description.reviewstatusRevieweden_US
dc.description.scholarlevelFacultyen_US
dc.identifier.citationHerrmann, N, Ismail, Z, Collins, R, et al. CCCDTD5 recommendations on the deprescribing of cognitive enhancers in dementia. Alzheimer's & Dementia: Translational Research & Clinical Interventions 8(1) 2022; 8:e12099. https://doi.org/10.1002/trc2.12099en_US
dc.identifier.urihttps://doi.org/10.1002/trc2.12099
dc.identifier.urihttp://hdl.handle.net/1828/13786
dc.language.isoenen_US
dc.publisherAlzheimer's & Dementia: Translational Research & Clinical Interventionsen_US
dc.subjectcholinesterase inhibitor
dc.subjectmemantine
dc.subjectcognitive enhancer
dc.subjectdementia
dc.subjectdeprescribing
dc.subjectdiscontinuation
dc.subject.departmentDivision of Medical Sciences
dc.subject.departmentSchool of Medical Sciences
dc.titleCCCDTD5 recommendations on the deprescribing of cognitive enhancers in dementiaen_US
dc.typeArticleen_US

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