Are Dementia Drugs Serving This Patient Well?

Charles P. Vega, MD


January 08, 2020

In this edition of Cases in Deprescribing, I present another clinical scenario drawn from my own practice. I'll tell you what I plan to do, but I'm most interested in crowdsourcing a response from all of you to collectively determine best practice. So please answer the polling question and contribute your thoughts in the comments section, particularly if you disagree with me.

The patient is a 78-year-old man with a 4-year history of Alzheimer disease (AD). He has been treated with rivastigmine since the time of his diagnosis, and he was started on memantine 2.5 years ago as his symptoms grew worse.

The patient has increasing forgetfulness and difficulty following even basic instructions. He lives with his wife, aged 76 years, who acts as his primary caregiver. The patient has not wandered off or gotten lost, but he has forgotten the names of two of his three children. He spends the day sleeping and watching television, but now only sleeps about 4 hours at night. He bathes himself and has no difficulty with ambulation, but he cannot cook, drive, or perform other complex tasks.

He was seen 2 months ago and prescribed sertraline for possible depression, although he denies ever having depression or anhedonia. He blames his "bad mood" on his wife for keeping him inside too much. However, he has not been agitated or disinhibited.

His only medical history is hypertension, which is under fair control with amlodipine. He takes no other medications.

A review of systems is positive for reduced appetite but no nausea, vomiting, or change in stool. He has difficulty hearing but will not wear his hearing aids.

The family is starting to evaluate long-term care facilities, and they want to simplify his medication regimen.


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