Understanding the progressive nature of dementia can help in the decision to continue or discontinue dementia medications in patients on hospice care for end-stage dementia. Goals change as patient’s progress from mild to severe dementia. In mild to moderate dementia, the primary goal is to slow the progression of the disease. As dementia nears its end stages, the goal of care generally shifts to the control of dementia symptoms.
Neither the cholinesterase inhibitors nor the NMDA receptor antagonists have been proven helpful in end-stage dementia. Both classes of dementia medications have the potential to cause significant adverse effects in declining patients whose bodies are less able to efficiently metabolize these medications. Diarrhea, loss of appetite, nausea, symptomatic slow heart rate, and fainting are all potential side effects of cholinesterase inhibitors. Interactions with other medications increase the risk for symptoms such as worsening of mental status, urinary retention, constipation, and dry mouth. Though some patients gain a small benefit from the continuation of dementia medications, the potential dangers of continuing dementia medications must be considered.
The decision to continue or discontinue dementia medications can seem difficult until it is realized that a simple discontinuation plan can guide therapy options and ease caregiver concerns. A prudent plan is to gradually discontinue dementia medications, monitoring patients for any new or worsening symptoms. Some symptoms are better managed with other medications commonly used to manage dementia symptoms at end of life. More often than not, patients do well with the discontinuation of medications, have less risk of adverse effects from their remaining medications, and are well managed with conventional symptom management.