Clinical Cases in Pharmacology Clinical Cases  ·  Psychiatry IV  ·  Neurocognitive Disorders  ·  Deprescribing Dementia Medications: Two Patients, Two Different Answers
Psychiatry IV, Case 0003 — Neurocognitive Disorders

Deprescribing Dementia Medications: Two Patients, Two Different Answers

Two families ask the same question about the same drug class at an advanced stage of the same disease. The pharmacology doesn't change between them — what changes is which outcomes the evidence was ever built to measure, and whether those are still the outcomes that matter.

Abbreviations, terms, and other agents mentioned in this case ADL — activities of daily living  ·  PEG — percutaneous endoscopic gastrostomy (feeding tube)
Presentation
Case A

Dorothy M., 86, was a church organist for over fifty years and, until eighteen months ago, could still pick out hymns from memory even after conversation had become difficult. She has advanced Alzheimer's disease, MMSE un-scoreable for over a year, but she remains ambulatory with assistance, recognizes her daughter's voice, and still smiles reliably at music. She lives in a memory-care facility and her daughter visits three times a week.

She has been on donepezil and memantine for six years. Her daughter, prompted by a friend whose mother's medications were "cleaned up" at a similar stage, asks today whether Dorothy still needs these drugs, or whether continuing them is really just inertia. There is no acute problem driving the question — no new swallowing difficulty, no medication burden crisis, no shift in goals of care. Dorothy's baseline, for her stage, has been stable for months, and the family's goals remain what they have been throughout: maximize her remaining function and quality of interaction for as long as that is realistic.

Dorothy M. · 86 Stable, Advanced Stage
History
Advanced Alzheimer's disease, dx 8y ago; hypertension, stable
Current regimen
Donepezil 10 mg + memantine 10 mg BID, ×6 years
Function
Ambulatory with assistance; responds to voice and music; no new decline this year
Swallowing
No dysphagia; eats independently with supervision
Goals of care
Maximize function and interaction; no shift toward comfort-only care
Trigger for today's question
No acute event — daughter asking based on a peer comparison
Consultation
Geriatrician Opening

I wouldn't stop either drug today. The most relevant trial here is DOMINO-AD — Howard and colleagues, New England Journal of Medicine, 2012 — 295 patients with moderate-to-severe Alzheimer's disease already on donepezil, randomized to continue or discontinue. The nursing-home finding comes from the trial's secondary and post-hoc analysis, published separately in Lancet Neurology in 2015: discontinuation significantly increased the risk of nursing-home placement within the first year, hazard ratio 2.09, and that difference didn't persist over the following three years.

Dorothy's situation — stable function, no new problem, family simply asking on principle — is almost exactly the population that trial enrolled. I don't see a reason today to deviate from what it found.

Clinical Pharmacologist Final

I'm not proposing we stop today either, but I want to name the limit of that trial honestly: it tested one year of follow-up in patients who'd been on donepezil a median of well under six years. We don't actually know what the risk-benefit balance looks like this far out, and "we've never re-checked in six years" is a real gap on its own, independent of what DOMINO-AD found.

I'd agree to continue today, but I'd want that gap named explicitly rather than treated as resolved by a trial that wasn't really testing Dorothy's specific six-year scenario.

Regimen selected
Donepezil
Cholinesterase Inhibitor · Continue 10 mg daily
Continued unchanged; DOMINO-AD's discontinuation-risk finding applies directly to a stable patient with no new problem driving the question.
Memantine
NMDA Receptor Antagonist · Continue 10 mg BID
Continued alongside donepezil; no new symptom or goals-of-care shift to prompt a change.
Discontinuation Today — Ruled Out
Considered, not adopted
Rejected for now given the absence of any new clinical trigger and the directly-relevant discontinuation-risk data.
Where this was left

Agreed: continue both medications unchanged. The daughter's question is documented as answered for today, not dismissed — the team commits to revisiting the decision explicitly if Dorothy's function, swallowing, or goals of care change.

Not agreed: whether six years on these drugs, on its own, should eventually trigger a scheduled reassessment independent of any new clinical event. The pharmacologist wants a standing checkpoint; the geriatrician sees no evidence-based interval to set one by and prefers to let clinical change, not the calendar, drive the next review.

The pivot · Case B shares the same drugs and the same disease stage — not the same goals of care
Case B

Harold P., 89, was Dorothy's exact contemporary in disease stage eight months ago; the two families in fact met once in the same waiting room. Since then Harold's course has diverged sharply. A hospital admission for aspiration pneumonia three months ago left his family and his physicians in agreement, after a long conversation, that his goals of care should shift to comfort-focused: no further hospitalization, no feeding tube, care aimed at minimizing distress rather than extending function. He is now enrolled in hospice.

He remains on donepezil and memantine, continued out of habit through the hospitalization and hospice enrollment rather than by any deliberate decision. He now has documented swallowing difficulty significant enough that his hospice nurse reports his oral medications, memantine in particular, are frequently followed by coughing and visible distress at administration. His daughter, present for today's hospice recertification visit, says plainly that watching him choke on pills twice a day, for medications she no longer understands the point of, is one of the hardest parts of her day.

Harold P. · 89 Comparative Case
History
Advanced Alzheimer's disease, same stage as Case A; recent aspiration pneumonia
Current regimen
Donepezil 10 mg + memantine 10 mg BID, continued through hospitalization by default
Swallowing
Documented dysphagia; coughing and distress with oral pill administration
Goals of care
Shifted to comfort-focused; enrolled in hospice 6 weeks ago
Function
Bed-bound; minimal responsiveness; no feeding tube per family wishes
Family experience
Daughter reports pill administration itself causes visible distress twice daily
What makes Harold's case categorically different from Dorothy's
It isn't a different drug or a different disease stage — it's that the outcomes DOMINO-AD measured (nursing-home placement, one-year functional trajectory) are no longer the outcomes that define good care for him. His goals of care have already shifted to comfort, and the act of taking the medication is itself now a source of the distress that shift was meant to reduce.
Consultation
Geriatrician Opening

For consistency with what I argued in Dorothy's case, I want to name that the same DOMINO-AD signal exists here too — there's some real, if small and unquantified, risk that stopping abruptly could accelerate decline in a way none of us would want to see in his remaining time.

I'm not going to argue hard for continuing, though. I think this case is different enough that I'd defer to palliative care's framing below.

Palliative Care Specialist Final

The DOMINO-AD outcome set — nursing-home placement, functional trajectory over a year — simply isn't the outcome set that governs Harold's care anymore. His family made an explicit, documented decision six weeks ago to shift toward comfort-focused care specifically because further aggressive management, including another hospitalization, was no longer what they wanted for him.

The concern about destabilizing him is worth naming, but the medication itself is causing a form of distress — coughing, visible discomfort twice a day — that comfort-focused care exists specifically to prevent. Continuing it isn't neutral; it's working against the goals his family already set.

Regimen selected
Donepezil — Discontinued
Cholinesterase Inhibitor · Tapered and stopped
Discontinued given documented dysphagia, hospice enrollment, and a goals-of-care shift that supersedes the outcome set the continuation evidence was built around.
Memantine — Discontinued
NMDA Receptor Antagonist · Tapered and stopped
Discontinued for the same reasons; specifically named by the family as the medication most associated with visible distress at administration.
Comfort-Focused Symptom Management
Hospice Standard of Care · Ongoing
Continues unchanged; the deprescribing decision is framed as removing a source of distress, not withdrawing care.
Where this was left

Agreed: both donepezil and memantine are tapered and discontinued, with the family informed this reflects the goals-of-care shift already made, not a withdrawal of care. Hospice nursing will monitor for any new agitation or decline in the two weeks following discontinuation.

Not agreed, and left explicitly on record: whether the same discontinuation-risk data should have been mentioned to the family at all today, given how little it seemed to actually apply. The geriatrician felt naming it was honest practice; the palliative care specialist worried it could needlessly reopen a decision the family had already made peace with.

Educational content only — a composite teaching case, not a real patient encounter or a substitute for clinical guidance. About These Cases →