Cochrane · systematic review · CD009081
Withdrawal or continuation of cholinesterase inhibitors or memantine or both, in people with dementia
Parsons, C, Lim, WY, Loy, C, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Dementia and Cognitive ImprovementAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
13
current version
GRADE rated
13
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 2 · 15.4%Low 8 · 61.5%Moderate 3 · 23.1%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Discontinued cholinesterase inhibitor compared to continued cholinesterase inhibitor in patients with dementia (short term, up to 2 months)
Population: patients with dementia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cognitive function (change from baseline, short term) Standardised mean difference (ADAS‐Cog/11, SMMSE, MMSE) Discontinued cholinesterase inhibitor vs continued cholinesterase inhibitor | no estimate extracted | 4 studies · 344 participants | Low Downgraded: risk of bias, imprecision |
Functional status (change from baseline, short term) Standardised mean difference (BADLS, ADCS‐ADL‐sev) Discontinued cholinesterase inhibitor vs continued cholinesterase inhibitor | no estimate extracted | 2 studies · 183 participants | Low Downgraded: risk of bias, imprecision |
Neuropsychiatric status (change from baseline, short term) Standardised mean difference (NPI, NPI‐NH) Discontinued cholinesterase inhibitor vs continued cholinesterase inhibitor | no estimate extracted | 2 studies · 136 participants | Low Downgraded: risk of bias, imprecision |
Discontinued cholinesterase inhibitor compared to continued cholinesterase inhibitor in patients with dementia (medium‐term, 3‐11 months)
Population: patients withdementia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cognitive function (change from baseline, medium term) Standardised mean difference (SMMSE, MMSE) Discontinued cholinesterase inhibitor vs continued cholinesterase inhibitor | no estimate extracted | 3 studies · 411 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Functional status (change from baseline, medium term) Standardised mean difference (BADLS, DAD) Discontinued cholinesterase inhibitor vs continued cholinesterase inhibitor | no estimate extracted | 2 studies · 314 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Neuropsychiatric status (change from baseline, medium term) Standardised mean difference (10 and 12‐item NPI) Discontinued cholinesterase inhibitor vs continued cholinesterase inhibitor | no estimate extracted | 3 studies · 410 participants | Low Downgraded: risk of bias, imprecision |
Discontinuing cholinesterase inhibitor compared with continuing cholinesterase inhibitor for patients with dementia (long‐term, 12 months or longer)
Population: patients with dementia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cognitive function (change from baseline, long term) SMMSE Discontinuing cholinesterase inhibitor vs continuing cholinesterase inhibitor | no estimate extracted | 1 study · 108 participants | Moderate Downgraded: imprecision |
Functional status (change from baseline, long term) BADLS Discontinuing cholinesterase inhibitor vs continuing cholinesterase inhibitor | no estimate extracted | 1 study · 109 participants | Moderate Downgraded: imprecision |
Neuropsychiatric status (change in NPI from baseline, long term) NPI Discontinuing cholinesterase inhibitor vs continuing cholinesterase inhibitor | no estimate extracted | 1 study · 108 participants | Moderate Downgraded: imprecision |
Discontinuing cholinesterase inhibitor compared to continued cholinesterase inhibitor for patients with dementia (all trial durations) Summary of findings
Population: patients with dementia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dropout due to lack of efficacy of trial medication or deterioration in overall medical condition Discontinuing cholinesterase inhibitor vs continued cholinesterase inhibitor | OR 1.53 [0.84, 2.76] | 4 studies · 583 participants | Low Downgraded: risk of bias, imprecision |
Adverse events (any) Discontinuing cholinesterase inhibitor vs continued cholinesterase inhibitor | OR 0.85 [0.57, 1.27] | 4 studies · 446 participants | Low Downgraded: risk of bias, imprecision |
Serious adverse events (SAEs) Discontinuing cholinesterase inhibitor vs continued cholinesterase inhibitor | OR 0.8 [0.46, 1.39] | 4 studies · 390 participants | Low Downgraded: risk of bias, imprecision |
Deaths Discontinuing cholinesterase inhibitor vs continued cholinesterase inhibitor | OR 0.75 [0.36, 1.55] | 5 studies · 598 participants | Low Downgraded: risk of bias, imprecision |