Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: a systematic review and meta-analysis

Abstract

We conducted a systematic review and meta-analysis investigating the influence of acetylcholinesterase inhibitors (AChEIs) therapy on nutritional status and weight across observational and interventional studies. Two authors searched major electronic databases from inception until 10/14/2015 for longitudinal, open-label and randomised double-blind placebo controlled (randomised controlled trials (RCTs)) studies of AChEIs in patients with dementia reporting nutritional status outcome data. Out of 3551 initial hits, 25 studies (12 open-label trials, 9 RCTs and 4 longitudinal studies) including 10 792 patients with dementia were meta-analysed. In longitudinal studies (median follow-up 6 months), a significant cumulative incidence of weight loss between baseline and follow-up evaluation was observed (studies=2; 5%; 95% CI 1% to 34%, p<0.0001; I=95%). These findings were confirmed in open-label trials (6%; 95% CI 4% to 7%, p<0.0001; I=78%). In 9 RCTs (median follow-up 5 months), those taking AChEIs more frequently experienced weight loss than participants taking placebo (OR=2.18; 95% CI 1.50 to 3.17, p<0.0001; I=29%). AChEIs therapy contributes to weight loss in patients with dementia, with a 2-fold increased risk observed in the meta-analysis of RCTs. Clinicians should carefully consider the benefit and risk of prescribing AChEIs. Nutritional status should be routinely evaluated in patients with dementia treated with AChEIs.

Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study

“…First, polypharmacy may contribute to the development of frailty through a negative influence on factors associated with frailty (such as comorbidities) or factors included in frailty definitions such as weight loss. 26,27 Further, polypharmacy has been linked to inappropriate prescribing, 28 low adherence, 29 preventable and unplanned hospitalization, 30 and adverse drug events, 31 all relevant to the development of frailty. This is particularly relevant to older individuals, who are more susceptible to adverse drug reactions, 32 also caused by commonly used medications.…”

Comparative muscle transcriptome associated with carcass traits of Nellore cattle

“…Soysal et al [77] concluded that acetylcholinesterase inhibitors could cause weight loss and change muscle mass index in elderly people. Despite not showing a direct relation with BFT, it is clear that this gene has a role during animal’s muscle growth.…”

Role of physical activity in ameliorating neuropsychiatric symptoms in Alzheimer disease: A narrative review

“…9,10 Additionally, they have serious adverse effects (eg sedation, postural hypotension, metabolic syndrome issues and electrolyte changes, drug interactions, cardiac arrhythmia, extrapyramidal symptoms, and falls). [10][11][12][13] Because of the complications associated with the pharmacological treatment, current guidelines recommend that nonpharmacological interventions should be attempted first, followed by the least harmful medication for the shortest time possible time. 14 Therefore, new interventions, added to drug therapy, are considered a potential alternative treatment to reduce or prevent NPs onset and recurrence.…”