Green Ariel R, Boyd Cynthia M, Quiles Rosalphie, Daddato Andrea E, Gleason Kathy, Taylor-McPhail Tobie, Wec Aleksandra, Nothelle Stephanie K, Boxer Rebecca S
Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, USA.
Drugs Aging. 2025 Sep;42(9):795-806. doi: 10.1007/s40266-025-01238-w. Epub 2025 Aug 26.
People with dementia (PWD) are frequently exposed to polypharmacy and potentially inappropriate medication use, in which the risks of medication use outweigh the benefits or the medication is not aligned with treatment goals. Appropriate deprescribing of unnecessary or potentially inappropriate medications is essential to high-quality care for PWD, to avoid iatrogenic harm and improve health and well-being for patients and their care partners. In this article, we review the risks of polypharmacy in PWD and evidence for the safety and efficacy of deprescribing in this population. Building off existing deprescribing frameworks for older adults with multimorbidity and limited life expectancy, we provide a roadmap for deprescribing in PWD that addresses the unique challenges of living dementia, including the variable disease course, high prevalence of distressing behavioral symptoms, and central role of care partners. The steps include: (1) identify potential targets for deprescribing by eliciting medication-related goals and considering tradeoffs, (2) develop a tapering plan, (3) complete additional actions that are necessary before deprescribing, and (4) provide close follow-up. Lastly, we provide evidence-based strategies for communicating with patients and their care partners about deprescribing, adapted from the FRAME tool.
痴呆症患者（PWD）经常面临多种药物联合使用以及潜在的不适当用药情况，即用药风险超过益处或药物与治疗目标不符。对不必要或潜在不适当的药物进行合理的撤药对于为PWD提供高质量护理至关重要，以避免医源性伤害并改善患者及其护理伙伴的健康和福祉。在本文中，我们回顾了PWD中多种药物联合使用的风险以及该人群撤药安全性和有效性的证据。基于现有的针对患有多种疾病且预期寿命有限的老年人的撤药框架，我们为PWD撤药提供了一个路线图，该路线图解决了痴呆症患者生活的独特挑战，包括疾病进程的多变性、令人痛苦的行为症状的高患病率以及护理伙伴的核心作用。这些步骤包括：（1）通过引出与药物相关的目标并考虑权衡来确定潜在的撤药目标，（2）制定逐渐减量计划，（3）在撤药前完成必要的其他行动，以及（4）进行密切随访。最后，我们提供基于证据的策略，用于与患者及其护理伙伴就撤药进行沟通，这些策略改编自FRAME工具。
