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Review
. 2025 Sep;42(9):795-806.
doi: 10.1007/s40266-025-01238-w. Epub 2025 Aug 26.

Deprescribing for People with Dementia: A Roadmap

Ariel R Green  1 , Cynthia M Boyd  2 , Rosalphie Quiles  2 , Andrea E Daddato  3 , Kathy Gleason  3 , Tobie Taylor-McPhail  3 , Aleksandra Wec  4 , Stephanie K Nothelle  2 , Rebecca S Boxer  5
Affiliations
Review

Deprescribing for People with Dementia: A Roadmap

Ariel R Green et al. Drugs Aging. 2025 Sep.

Abstract

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.

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Conflict of interest statement

Declarations. Funding: The research by Dr. Green, et al. that informed this manuscript was funded by the National Institute on Aging (NIA) of the National Institutes of Health under award numbers U54AG063546, which funds NIA Imbedded Pragmatic Alzheimer's and AD-Related Dementias Clinical Trials Collaboratory (NIA IMPACT Collaboratory), and R01AG077011. Dr. Nothelle acknowledges funding from her NIA K23 award (K23AG072037). A. Wec was supported by NIH/NIA T32AG066576. Confict of interest: Dr. Boyd reported receiving royalties from UpToDate for writing a chapter on multi-morbidity and honoraria from Dynamed for reviewing a chapter on falls outside the submitted work. ARG, RQ, AED, KG, TTM, AW, SKN, and RSB report no disclosures. Ethics approval: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable. Availability of data and material: Not applicable. Code availability: Not applicable. Author contributions: A.R.G., R.Q., A.E.D., K.G., T.T.M., A.W., and R.S.B. contributed to the conception and design of the roadmap. A.R.G. drafted the manuscript, and all of the authors, including C.M.B. and S.K.M., revised and edited the manuscript. All of the authors read and approved the final manuscript.

Figures

Fig. 1
Fig. 1
Factors that increase the risk of adverse drug effects for PWD
Fig. 2
Fig. 2
Adapted roadmap for deprescribing in PWD. PWD people with dementia, CP care partner
See this image and copyright information in PMC

References

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