When do we discontinue anti-dementia drugs? Views expressed by clinicians in a national survey within the United Kingdom

摘要

The use of anti-dementia medication is expected to rise with increasing demand and a growing elderly population. With the implementation of the "Living well with Dementia: National Dementia Strategy" document in the United Kingdom, there is an increased awareness along with an urge for early diagnosis and initiation of treatment. Eligibility for starting treatment with both acetylcholinesterase inhibitors (AChEIs) and memantine has been scrutinized quite closely in UK National Health Service organizations as these medications were expensive and most places had been extremely vigilant to monitor the appropriate use of these drugs. However, the circumstances of cessation of this group of medications have not been subjected to the same level of attention and analysis. With the huge cost implications associated with some of these compounds becoming generic, it will be worthwhile to explore whether this will affect the duration of treatment of dementia patients. Recently published evidence from the "Donepezil and Memantine for Moderate-to-Severe Alzheimer's Disease" (DOMINO-AD) study (Howard et al, 2012) suggested the benefit of continuing AChEIs in severe stages of Alzheimer's disease. We conducted a national survey to explore in what circumstances clinicians within the United Kingdom feel it appropriate to discontinue anti-dementia medication and whether their prescribing practice will be affected with the advent of cheaper generic alternatives, and the latest research evidence suggesting benefit of continuing anti-dementia medications in the severe stages of Alzheimer's Disease. The primary aim of this project was to get an overview of the practice followed within the country. The response generated from this survey provides us with valuable data toward developing a consensus or clinical guideline regarding future prescribing of anti-dementia medication.