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121. Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine

that is characterised by a progressive loss in cognition, function and behaviour [1]. Worldwide, the number of people living with dementia is increasing every year [2]. There are currently two classes of medications available to treat the symptoms of dementia: cholinesterase inhibitors (ChEIs: donepezil, rivastigmine and galantamine) and the N- methyl-D-aspartate (NMDA) receptor antagonist, memantine [3]. These medications are not disease modifying, yet they can have important benefits to people with dementia (...) and harm to the individual. Thus, the purpose of this guideline is to assist healthcare professionals (particularly prescribers) to determine when it might be suitable to trial withdrawal of these medications for an individual. These recommendations only apply to individuals already taking one of the described medications (donepezil, rivastigmine, galantamine and/or memantine). The main points of this guideline are as follows: ? A proportion of people who have used these medications for over 12 months

2018 Clinical Practice Guidelines Portal

123. Management of aggression, agitation and behavioural disturbances in dementia: carbamazepine

and behavioural disturbances in dementia: carbamazepine (ESUOM40) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 18 of 21In 2006, NICE published a guideline on dementia: supporting people with dementia and their carers in health and social care (NICE guideline CG42), which has been incorporated into a NICE pathway. NICE guidance is also available on donepezil, galantamine, rivastigmine and memantine for the treatment

2015 National Institute for Health and Clinical Excellence - Advice

124. Parkinson's disease in adults.

of dementia with Lewy bodies. 6 At the time of publication (July 2017), rivastigmine capsules are the only treatment with a UK marketing authorisation for this indication. Donepezil, galantamine and rivastigmine patches did not have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's for further information. 7

2017 National Guideline Clearinghouse (partial archive)

126. Vesicular Monoamine Transporter 2 Inhibitors for Tardive Dyskinesia: Effectiveness and Value

be effective in reducing TD symptoms; the use of galantamine, eicosapentaenoic acid, and diltiazem was discouraged. Table B1 in the Appendix lists the interventions evaluated in the AAN guidelines. National Institute for Health Research 23 https://www.journalslibrary.nihr.ac.uk/hta/hta21430#/abstract A more recent systematic review sponsored by the U.K. National Institute for Health Research reported similar results. This review found insufficient evidence due to small and low-quality studies, leading

2017 California Technology Assessment Forum

130. Stopping Donepezil may be linked to nursing home placement for people with Alzheimer’s disease, but a “cause and effect” not conclusive

the four year study period. The participants in each group had similar characteristics and stage of disease at the beginning of the trial, but we don’t know what medication they took in the last three years of the study. The authors considered that the overall trial design was representative of usual care. What does current guidance say on this issue? NICE 2011 guidance recommends donepezil (or one of the related acetyl cholinesterase inhibitors, galantamine or rivastigmine) as a medical option (...) characteristics and stage of disease at the beginning of the trial, but we don’t know what medication they took in the last three years of the study. The authors considered that the overall trial design was representative of usual care. What does current guidance say on this issue? NICE 2011 guidance recommends donepezil (or one of the related acetyl cholinesterase inhibitors, galantamine or rivastigmine) as a medical option to treat cognitive symptoms of mild to moderate Alzheimer’s disease, provided

2018 NIHR Dissemination Centre

131. Recommendations on screening for cognitive impairment in older adults

important change. The MMSE and the MoCA tools are commonly used by Canadian clinicians in clinical practice. 14 Treatments include medications such as cho- linesterase inhibitors (i.e., donepezil, rivastigmine and galantamine), dietary supplements and vita- mins, and nonpharmacologic interventions such as exercise, and cognitive training and rehabili- tation. 10 Provincial payment for the medications used in primary care practice is often linked to cognitive assessment scores measured by the screening (...) interventions approved for use in Canada (e.g., cholinesterase inhibitors, such as donepezil, rivastigmine and galantamine), dietary supplements or vitamins and nonpharmacologic interventions (e.g., exer- cise, cognitive training and rehabilitation). The task force workgroup decided to treat the key question regarding the accuracy of screening tools (key question 6 in Appendix 2) as a contex- tual question. This was because there were no trials of screening programs and there was evi- dence that treatment

2015 CPG Infobase

132. Pharmacological interventions for cognitive decline in people with Down syndrome. Full Text available with Trip Pro

Pharmacological interventions for cognitive decline in people with Down syndrome. People with Down syndrome are vulnerable to developing dementia at an earlier age than the general population. Alzheimer's disease and cognitive decline in people with Down syndrome can place a significant burden on both the person with Down syndrome and their family and carers. Various pharmacological interventions, including donepezil, galantamine, memantine and rivastigmine, appear to have some effect

2015 Cochrane

133. Clinical practice guidelines for dementia in Australia Full Text available with Trip Pro

that the person with dementia (or their carer[s] or family) make an appointment to see a dentist to conduct an assessment and formulate a long-term treatment plan. Acetylcholinesterase inhibitors and memantine are routinely prescribed for people with mild to moderate Alzheimer disease in order to delay functional decline, and the guidelines support their use. Based on recent evidence, the guidelines also state that any one of the three acetylcholinesterase inhibitors (donepezil, galantamine or rivastigmine (...) Education Services, Department of Health and Ageing Pharmaceutical Policy Branch, Ahmed R. Post market review: Pharmaceutical Benefits Scheme anti-dementia medicines to treat Alzheimer disease. Canberra: Department of Health, 2012. (accessed Jan 2016). Birks J, Craig D. Galantamine for vascular cognitive impairment. Cochrane Database Syst Rev 2006; (1): CD004746. Birks J, McGuinness B, Craig D. Rivastigmine for vascular cognitive impairment. Cochrane Database Syst Rev 2013; (5): CD004744. Malouf R

2016 MJA Clinical Guidelines

134. Cochrane team criticises the ECDC experts' draft advice on oseltamivir use

agents”, had been approved for treatment of dementia in the past [8-10]. Between 1998 and 1999, most of them were taken off the market. None of the medicines approved in or before 1998 still hold a clear indication for treatment of dementia today. Currently, only 4 medicines are indicated for treatment of dementia like in other countries; namely donepezil (brand name: Aricept etc.); cholinesterase inhibitors, galantamine Abstract ?Memantine (brand name: Memary), which was launched in 2011, increases

2016 Med Check - The Informed Prescriber

136. Dementia

(NICE) guidelines Dementia: supporting people with dementia and their carers in health and social care [ ] and Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset [ ], the NICE Technology Appraisal Donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer's disease [ ], the European Federation of Neurological Societies (EFNS-ENS) Guidelines on the diagnosis and management of disorders associated with dementia [ ], and the Guidelines (...) . May 2011 — minor update. The 2011/2012 QOF indicators and the 2010/2011 QIPP options for local implementation have been added to this topic. Issued in June 2011. April 2011 — minor update. Text added to reflect new recommendations from NICE regarding acetylcholinesterase inhibitors and memantine: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease . Issued in June 2011. July 2010 — minor update. The NICE quality standard relating to dementia have been added

2019 NICE Clinical Knowledge Summaries

138. Drugs to avoid in 2015

of their disproportionate adverse effects and many interactions with other drugs. None of the available drugs has been shown to slow progression toward dependency, yet all carry a risk of life-threatening adverse effects and severe drug inter - actions (Prescrire Int n° 128 and Rev Prescrire n° 363, 364). It is better to focus on reorganising the patient’s daily life, keeping him or her active, and providing support and help for caring relatives. – Donepezil, galantamine and rivastigmine, three cholinesterase

2015 Prescrire

140. Effect of Idalopirdine as Adjunct to Cholinesterase Inhibitors on Change in Cognition in Patients With Alzheimer Disease: Three Randomized Clinical Trials. Full Text available with Trip Pro

patients at 119 sites; study 2: n = 858 at 158 sites; and study 3: n = 734 at 126 sites). The 24-week studies were conducted from October 2013 to January 2017; final follow-up on January 12, 2017.Idalopirdine (10, 30, or 60 mg/d) or placebo added to cholinesterase inhibitor treatment (donepezil in studies 1 and 2; donepezil, rivastigmine, or galantamine in study 3).Primary end point in all 3 studies: change in cognition total score (range, 0-70; a lower score indicates less impairment) from baseline

2018 JAMA Controlled trial quality: predicted high

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