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.