Cognitive enhancers (cholinesterase inhibitors and memantine) are used in patients with dementia (called major neurocognitive disorder in DSM-5-TR™) of several different types. But, once they are started, they are often continued indefinitely. Yet, their potential benefits and the risk of harms can change over time (Reeve et al., 2019). Importantly, deprescribing cholinesterase inhibitors may reduce the risk of serious falls or fractures (Niznik et al., 2020).
Cholinesterase inhibitors were one of the types of medications for which clinicians said that a deprescribing guideline would be useful (Farrell et al., 2015). But, in the past, textbooks and practice guidelines provided little specific guidance regarding deprescribing cholinesterase inhibitors (Renn et al., 2018).
More recent practice guidelines have provided specific, helpful recommendations about when and how to desprescribe cholinesterase inhibitors, which will be summarized below. Recommendations for deprescribing memantine will be discussed in a separate article on this website.
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