Study: Stopping Certain Dementia Medications May Ease Treatment Burden Without Raising Nursing Home Risk

A new study published in JAMA Network Open suggests that discontinuing cholinesterase inhibitors when starting memantine treatment for Alzheimer’s disease and related dementias in older adults may reduce the treatment burden without increasing the risk of nursing home admission. The research, led by Dae Hyun Kim, MD, MPH, ScD, associate scientist at Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research, provides valuable insights for clinicians and patients managing dementia care.

Key findings include: 

• Discontinuing cholinesterase inhibitors when starting memantine did not significantly affect the time to nursing home admission over one year.
• Patients who discontinued cholinesterase inhibitors had a lower risk of fall-related injuries.
• There was no significant difference in mortality rates between those who discontinued and those who continued cholinesterase inhibitors.

“Routinely, cholinesterase inhibitors are prescribed for the treatment of Alzheimer’s disease and related dementias, followed by memantine when patients progress to moderate-to-severe dementia. Other studies show an uncertain clinically meaningful benefit to that combination of therapies,” said Dr. Kim. “Our study found that patients who discontinued cholinesterase inhibitors did not see an increase in long-term care stays along with a decrease in fall-related injuries.”

Entitled “Discontinuation of Cholinesterase Inhibitors Following Initiation of Memantine and Admission to Long-Term Care Among Older Adults,” the research analyzed Medicare claims data from 3,612 beneficiaries with dementia who were taking cholinesterase inhibitors and started memantine treatment. The study compared outcomes between those who discontinued cholinesterase inhibitors and those who continued them.

This research has important implications for dementia care, potentially leading to reduced medication burden and health care costs for patients. However, the authors caution that decisions about medication should be made on an individual basis, considering each patient’s specific circumstances.

Co-authors of the study include:

• Yu-Chien-Lee, MD, MPH, Department of Family Medicine, Chang Gung Memorial Hospital, Taiwan
• Sandra M. Shi, MD, MPH, assistant scientist II, Marcus Institute, Hebrew SeniorLife
• Stephanie M. Sison, MD, MBA, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
• Chan Mi Park, MD, MPH, assistant scientist I, Marcus Institute, Hebrew SeniorLife 
• Gahee Oh, MD, MPH, data scientist II, Marcus Institute, Hebrew SeniorLife 
• Sohyun Jeong, PhD, Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Science, Boston
• Ellen P. McCarthy, PhD, MPH, associate scientist, Marcus Institute, Hebrew SeniorLife
• Dae Hyun Kim, MD, MPH, ScD, associate scientist, Marcus Institute, Hebrew SeniorLife

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 4,500 seniors a day across campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; Jack Satter House, Revere; and Leyland Community, Dorchester. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $98 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 500 geriatric care providers each year. For more information about Hebrew SeniorLife, follow us on our blog, Facebook, Instagram, Threads, and LinkedIn.