SynthesisThe American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry2018
A Systematic Review of Practice Guidelines and Recommendations for Discontinuation of Cholinesterase Inhibitors in Dementia.
Synthesis in The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 4 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- Practical Considerations of PRN Medicines Management: An Integrative Systematic Review.Frontiers in pharmacology · 2022Pooled it
- Protection against discrimination in national dementia guideline recommendations: A systematic review.PLoS medicine · 2022Pooled it
- Withdrawal or continuation of cholinesterase inhibitors or memantine or both, in people with dementia.The Cochrane database of systematic reviews · 2021Pooled it
- Transcranial Direct Current Stimulation (tDCS) as a Useful Rehabilitation Strategy to Improve Cognition in Patients With Alzheimer's Disease and Parkinson's Disease: An Updated Systematic Review of Randomized Controlled Trials.Frontiers in neurology · 2021Pooled it
- Trial
- Article
- Fractional amplitude of low-frequency fluctuations in right dorsal cingulum bundle associated with depression symptoms in AD patients: effects of donepezil intervention.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Article
- Data-independent acquisition proteomic analysis of the brain microvasculature in Alzheimer's disease identifies major pathways of dysfunction and upregulation of cytoprotective responses.Fluids and barriers of the CNS · 2024Article
- Geographic Variation of Antidementia and Antipsychotic Medication Use Among US Nursing Home Residents With Dementia.Medical care · 2024Article
- Antidementia Medication Use in Nursing Home Residents.Journal of geriatric psychiatry and neurology · 2024Article
- The increased effective connectivity from left middle occipital gyrus to right medial septum/diagonal bands in AD patients after donepezil intervention.Frontiers in aging neuroscience · 2024Article
- Changes in Antidementia Medications upon Admission to the Nursing Home: Who Decides and Why? Results From a National Survey of Nursing Home Administrators.Journal of the American Medical Directors Association · 2024Article
- Therapeutic dilemmas: cognitive enhancers and risk of falling in older adults-a clinical review.European geriatric medicine · 2023Review
- Evaluation of Antipsychotic Reduction Efforts in Patients With Dementia in Veterans Health Administration Nursing Homes.The American journal of psychiatry · 2022Article
- Psychoactive medication use and risk of suicide in long-term care facility residents.International journal of geriatric psychiatry · 2022Article
- CCCDTD5 recommendations on the deprescribing of cognitive enhancers in dementia.Alzheimer's & dementia (New York, N. Y.) · 2022Article
- PRN Medicines Management for Older People with Long-Term Mental Health Disorders in Home Care.Risk management and healthcare policy · 2021Review
- Adverse Drug Reactions of Acetylcholinesterase Inhibitors in Older People Living with Dementia: A Comprehensive Literature Review.Therapeutics and clinical risk management · 2021Review
- Prescribing medications of questionable benefit prior to death: a retrospective study on older nursing home residents with and without dementia in Germany.European journal of clinical pharmacology · 2020Article
- Impact of deprescribing AChEIs on aggressive behaviors and antipsychotic prescribing.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
Cholinesterase inhibitors (ChEIs) are the primary pharmacological treatment for symptom management of Alzheimer disease (AD), but they carry known risks during long-term use, and do not guarantee clinical effects over time. The balance of risks and benefits may warrant discontinuation at different points during the disease course. Indeed, although there is limited scientific study of deprescribing ChEIs, clinicians routinely face practical decisions about whether to continue or stop medications. This review examined published practice recommendations for discontinuation of ChEIs in AD. To characterize the scientific basis for recommendations, we first summarized randomized controlled trials of ChEI discontinuation. We then identified practice guidelines by professional societies and in textbooks and classified them according to 1) whether they made a recommendation about discontinuation, 2) what the recommendation was, and 3) the proposed grounds for discontinuation. There was no consensus in guidelines and textbooks about discontinuation. Most recommended individualized discontinuation decisions, but there was essentially no agreement about what findings or situations would warrant discontinuation, or even about what domains to consider in this process. The only relevant domain identified by most guidelines and textbooks was a lack of response or a loss of effectiveness, both of which can be difficult to ascertain in the course of a progressive condition. Well-designed, long-term studies of discontinuation have not been conducted; such evidence is needed to provide a scientific basis for practice guidelines. It seems reasonable to apply an individualized approach to discontinuation while engaging patients and families in treatment decisions. .
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.