In recent years, medications have been marketed to delay the progression of dementia.
1. Cholinesterase Inhibitors (ChEIs): e.g. galantamine
Indication: mild to moderate dementia—usually started as first line agents. ChEIs lead to cognitive, functional, and global benefits in mild to moderate dementia which wane at about one year after initiation and are of relatively unclear clinical significance. Some studies have suggested ChEIs have a role in controlling behavior problems and lessening opioid related somnolence. Side effects: diarrhea, nausea, anorexia, insomnia, bradycardia.
2. N-methyl-D-aspartate (NMDA) receptor antagonist: memantine
Indication: moderate to severe dementia. Studies suggest a modest beneficial effect with decreased cognitive and functional decline in patients with moderate to severe dementia. Side effects: dizziness, headache, constipation, somnolence, weight gain
No studies have specifically addressed when or if these drugs should be stopped as cognition and function decline in serious illness.
When palliative care professionals are asked about the continued role of these drugs in the face of a limited prognosis it is suggested to use a shared decision-making model with patients/surrogates guided by the goals of care (e.g. life prolongation and/or symptom relief), carefully weighing the expected benefits and burdens - these medications may be viewed as prolonging a poor quality of life and/or the process of dying.
See reference for more information.
Adapted from Morrison LJ, Liao S. Dementia medications in palliative care. Palliative Care Network of Wisconsin. Fast facts and concepts #174. Internet. Accessed on January 5, 2019.