Dementia Medications and Risk of Falls, Syncope, and Related Adverse Events: Meta-Analysis of Randomized Controlled Trials

Abstract

Background Conflicting evidence exists on whether cholinesterase inhibitors and memantine increase the risk of falls, syncope, and related events, defined as fracture and accidental injury. Objectives To evaluate the effect of cholinesterase inhibitors and memantine on the risk of falls, syncope, and related events Design, Setting, Participants, and Intervention Meta-analysis of 54 placebo-controlled randomized trials and extension studies of cholinesterase inhibitors and memantine that reported falls, syncope, and related events in cognitively impaired older adults. Trials were identified from MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (no language restriction, through July 2009), and manual search. Measurements Falls, syncope, fracture, and accidental injury Results Compared to placebo, cholinesterase inhibitor use was associated with an increased risk of syncope (odds ratio [95% confidence interval]: 1.53 [1.02-2.30]), but not with other events (falls: 0.88 [0.74-1.04]; fracture: 1.39 [0.75-2.56]; accidental injury: 1.13 [0.87-1.45]). Memantine use was associated with fewer fractures (0.21 [0.05-0.85]), but not with other events (fall: 0.92 [0.72-1.18]; syncope: 1.04 [0.35-3.04]; accidental injury: 0.80 [0.56-1.12]). There was no differential effect by type and severity of cognitive impairment, residential status, nor length of follow-up. However, due to underreporting and small number of events, a potential benefit or risk cannot be excluded. Conclusion Cholinesterase inhibitors may increase the risk of syncope, with no effects on falls, fracture, and accidental injury in cognitively impaired older adults. Memantine may have a favorable effect on fracture, with no effects on other events. More research is needed to confirm the reduction in fractures observed for memantine.

The Use of Cholinesterase Inhibitors Across All Stages of Alzheimer’s Disease

“…Among a cohort of patients in the New England Veterans Affairs Healthcare System, the use of ChEIs was associated with a modest increased risk of bradycardia (adjusted hazard ratio 1.4) [52]. In a metaanalysis of RCTs, the use of ChEIs was associated with a greater risk of syncope but not falls, fracture, or accidental injury [53]. Combined, the results of these studies highlight the importance of careful monitoring given the potential serious nature of these AEs in an elderly population.…”

Potential analysis for research on occupational therapy-led physical exercise programmes and home environment adaptation programmes to prevent falls for elderly people living at home / Potenzialanalyse zu ergotherapeutischen körperlichen Trainingsprogrammen und Wohnraumanpassungen zur Vermeidung von Stürzen bei zu Hause lebenden älteren Menschen

“…Stürze ohne ernste Verletzungsfolgen werden sowohl von älteren Menschen als auch von dem medizinischen Fachpersonal oftmals bagatellisiert, sodass präventive Maßnahmen versäumt oder zu spät eingeleitet werden, was wiederum Folgekosten für das Gesundheitswesen nach sich zieht (Zecevic, Salmoni, Speechley, & Vandervoort, 2006). Dieses Phänomen lässt die Dunkelziffer bei Stürzen zusätzlich ansteigen (Kim, Brown, Ding, Kiel, & Berry, 2011). (Weberberger, 2010) und Programme (Geißer, 2010), die im Routinealltag unter Best-PracticeGesichtspunkten durchgeführt werden (Becker, & Lenz, 2011;Lindemann, Schiele, & Tiedemann, 2005 (Becker et al, 2005;Thapa-Görder, & Voigt-Radloff, 2010).…”

Should Respond Change Falls Prevention in Parkinson'S Disease?

“…Dizziness was more common in the rivastigmine group; other trials of medications for dementia report more syncope in the treatment arms. 9 While recent studies of acetylcholinesterase inhibitors in Alzheimer's disease also support an improvement in gait variability, 10 a systematic review of studies using acetylcholinesterase therapy in PD patients showed no improvement in falls risk. 11 So should we start using rivastigmine to prevent falls in patients with PD?…”