Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland.
Drugs Aging. 2010 Jun 1;27(6):435-49. doi: 10.2165/11536760-000000000-00000.
Recent years have seen a growing recognition that dementia is a terminal illness and that patients with advanced dementia nearing the end of life do not currently receive adequate palliative care. However, research into palliative care for these patients has thus far been limited. Furthermore, there has been little discussion in the literature regarding medication use in patients with advanced dementia who are nearing the end of life, and discontinuation of medication has not been well studied despite its potential to reduce the burden on the patient and to improve quality of life. There is limited, and sometimes contradictory, evidence available in the literature to guide evidence-based discontinuation of drugs such as acetylcholinesterase inhibitors, antipsychotic agents, HMG-CoA reductase inhibitors (statins), antibacterials, antihypertensives, antihyperglycaemic drugs and anticoagulants. Furthermore, end-of-life care of patients with advanced dementia may be complicated by difficulties in accurately estimating life expectancy, ethical considerations regarding withholding or withdrawing treatment, and the wishes of the patient and/or their family. Significant research must be undertaken in the area of medication discontinuation in patients with advanced dementia nearing the end of life to determine how physicians currently decide whether medications should be discontinued, and also to develop the evidence base and provide guidance on systematic medication discontinuation.
近年来，人们越来越认识到痴呆是一种终末期疾病，而且目前生命末期的晚期痴呆症患者没有得到足够的姑息治疗。然而，迄今为止，针对这些患者的姑息治疗研究还很有限。此外，文献中很少讨论生命末期的晚期痴呆症患者的药物使用问题，尽管停止用药可能会减轻患者的负担并提高生活质量，但对其的研究还不够充分。文献中提供的指导乙酰胆碱酯酶抑制剂、抗精神病药、HMG-CoA 还原酶抑制剂（他汀类药物）、抗菌药物、抗高血压药、抗高血糖药和抗凝剂等药物停药的证据有限，有时甚至相互矛盾。此外，晚期痴呆症患者的临终关怀可能因准确估计预期寿命的困难、关于 withholding 或 withdrawal 治疗的伦理考虑以及患者和/或其家属的意愿而变得复杂。必须在生命末期的晚期痴呆症患者的药物停药领域进行重大研究，以确定医生目前如何决定是否应停止用药，并为系统药物停药提供证据基础和指导。
