Of course, these decisions are made in partnership with a physician, but after the doctor provides the rationale for their recommendations, they will probably ask you for your opinion. So, what to do? First, acknowledge that this can be a stressful decision to make. And second, learn all you can about what research has demonstrated about this decision.
Benefits of Medications
Medications are prescribed for people with dementia with the hope of slowing down the progression or even improving the cognitive functioning for a time. Research has shown that there is often some benefit from these medications, although they don’t cure the disease.
Treating Alzheimer’s Disease
There are three types of medications prescribed to treat Alzheimer’s disease.
Cholinesterase Inhibitors
Aricept (donepezil): Approved for mild, moderate, and severe Alzheimer’s Adlarity (donepezil transdermal patch): Approved for mild, moderate, and severe Alzheimer’s Exelon (rivastigmine): Approved for mild to moderate Alzheimer’s Razadyne (galantamine): Approved for mild to moderate Alzheimer’s
N-Methyl D-Aspartate (NMDA) Antagonists
Namenda (memantine) is another medication that is used to try to slow down the progression of dementia and is approved for use in moderate to severe Alzheimer’s disease.
Amyloid Beta-Directed Antibody
Aduhelm (aducanumab) is the only drug approved for Alzheimer’s that is directed at reducing amyloid beta plaques in the brain—the underlying cause of the disease.
Why Discontinue Medications
Consider discontinuing medications when one or both of the following two factors arise:
Side Effects: If there are too many side effects or they diminish the quality of life for the person, strong consideration should be given towards discontinuing the medication. No Benefit: If the patient or loved one has been on the medication for quite some time and now her dementia has progressed to the late stages, physicians and pharmacists will sometimes recommend discontinuing the medication if there is no observed benefit. This decision may, at times, be made when a person elects hospice care, but at other times it is considered as an option simply if the perceived benefit is little or none.
How Medications Should Be Discontinued
Medications should be discontinued gradually and one at a time. When discontinuing medications, monitor your loved one or patient closely. If you start to see a significant decline in cognition or behavior, you may want to ask the physician to restart the medication.
If a notable decline in functioning develops after discontinuation, restarting the medication sooner rather than later may increase the likelihood of the person returning close to his previous (prior to stopping the medicine) level of functioning.
What Research Has Shown
There has not been a lot of research conducted on stopping medications for the treatment of dementia. However, some research seems to indicate that people whose dementia medications were discontinued declined in cognition and behavior more quickly.
One study compared nursing home residents with dementia who were receiving cholinesterase inhibitor medications to treat dementia to other nursing home residents whose cholinesterase inhibitors were discontinued.
The researchers found that those whose medications were discontinued experienced more behavioral challenges such as repetitive questioning and frequent health concerns. This group also participated less in activities compared to those who were still on their medication.
Make an Educated Decision
There can be a range of results after medications for dementia have been discontinued. At times, there has been a decline in functioning as described above after discontinuing the medications, and there have also been other situations where there was very little change, if any, after medications for dementia were discontinued. The key is for family members to be aware that the possibility for decline exists and to make this decision together with their loved one’s physician.
A Word From Verywell
One physician proposed the following question when considering whether or not to discontinue medication for the treatment of Alzheimer’s disease:
“Is there anything going on in this life that is good and might be missed if the medication is stopped?” (Dr. Gene Lammers)
The decision to continue or stop medication in Alzheimer’s disease should be one that is based on each individual’s preferences and level of functioning. Perhaps considering the above question will be helpful to clarify your next steps as you seek your loved one’s best interests.
