Doctors warn against Aricept for dementia care, supplements for weight control in second annual 'Choosing Wisely' list

Share this article:
Doctors warn against Aricept for dementia care, supplements for weight control in second annual 'Cho
Doctors warn against Aricept for dementia care, supplements for weight control in second annual 'Cho

Clinicians should prescribe cholinesterase inhibitors very cautiously and suspend use if dementia symptoms aren't reduced within 12 weeks, according to new “Choosing Wisely” recommendations from the American Geriatrics Society.

The American Board of Internal Medicine launched Choosing Wisely in 2012 to help improve patient care while cutting down on overused healthcare resources. More than 100 partner organizations have identified potentially unnecessary and/or harmful tests, medications and procedures.

Cholinesterase inhibitors such as Aricept and Exelon increase levels of the brain chemical acetylcholine. This has been associated with slightly improved cognitive function in those with Alzheimer's disease, according to the AGS.

However, little is known about the long-term risks and benefits of being on an inhibitor, and it could cause “adverse gastrointestinal effects,” the group notes.

Behavioral interventions and other non-pharmacologic approaches also should be part of a treatment plan that calls for a cholinesterase inhibitor, the AGS recommends. Physicians should carefully monitor the medication's effectiveness and take nonresponsive patients off the drug, the association urges.

Some previous studies have suggested more widespread and prolonged Aricept use could be beneficial.

Caregivers also should seek to avoid giving high-calorie supplements to control weight in the “medically ill or frail elderly,” according to the recommendations issued Thursday. This is because supplements such as megestrol acetate offer minimal benefits while increasing the risk of death.

Other recommendations call on clinicians to stop using physical restraints in cases of delirium and to do drug regimen reviews to avoid unnecessary polypharmacy, which occurs when a patient is taking multiple medications. Breast, colorectal and prostate cancer screening should be evaluated carefully, according to the AGS.

Last year's recommendations included reducing antipsychotic prescribing for dementia care and suspending the use of percutaneous feeding tubes for those with dementia.

The AGS recommendations were published online in the Journal of the American Geriatrics Society.

Share this article:

More in News

Bulk of Medicaid to be managed care in two years: Avalere

Bulk of Medicaid to be managed care in ...

More than three-quarters of Medicaid beneficiaries will be enrolled in a managed care plan as of 2016, according to an Avalere Health analysis released Thursday. The numbers reveal that managed ...

Nursing home asked for employee's personal information too often, jury rules

The human resources department of a Maine nursing home did not properly protect a former employee's personal identification information, a jury recently ruled.

Test could confirm sepsis within an hour

Nursing home residents might benefit from a new way of diagnosing and treating sepsis made possible by discoveries out of the University of British Columbia.