치매에서 콜린에스터레이스 억제제 탈처방 : 한국형 임상진료지침 개발을 위한 국외 실무 지침 스코핑 리뷰 = Deprescribing Cholinesterase Inhibitors in Dementia : A Scoping Review of International Practice Guidance to Inform Korean Guideline Development

다국어 초록 (Multilingual Abstract)

Background : South Korea is experiencing a rapidly aging population, leading to an increase in the prescription of anti-dementia drugs. Despite this trend, standardized protocols for discontinuing these medications are not yet established. This study aims to analyze international deprescribing guidelines for cholinesterase inhibitors to lay the groundwork for developing clinical practice guidelines specific to Korea.
Methods : A scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We searched MEDLINE, EMBASE, the Cochrane Library, and grey literature for guidelines published between 2015 and 2025. The Template for Intervention Description and Replication checklist was used to systematically extract details about interventions, including deprescribing criteria, tapering protocols, and the involvement of pharmacists.
Results : Thirteen publications were identified, primarily focusing on severe Alzheimer’s disease in commu nity settings and nursing homes. Common triggers for deprescribing included the absence of cognitive benefits and adverse events. Most guidelines (61.5%) did not provide specific quantitative values for deprescribing criteria, such as Mini-Mental State Examination or Functional Assessment Staging Tool scores. While most guidelines recommended tapering, only 23.1% included shared decision-making tools. Additionally, the explicit role of pharmacists in employing screening tools like the American Geriatrics Society Beers Criteria was mentioned in only 15.4% of the studies.
Conclusion : Current international guidelines offer a foundation for deprescribing but lack clinical consensus on the optimal timing for drug discontinuation, standardized shared decision-making processes, and clearly defined roles for pharmacists. To enhance dementia care in Korea, it is essential to develop a Korean-specific guideline that encourages periodic re-evaluation, integrates standardized shared decision-making tools, and strengthens pharmacist-led medication reviews to ensure patient safety.