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Got It, Hide thisIn people with cognitive impairment, cholinesterase inhibitors reduce risk for falls but increase risk for fainting
Ahuja M, Siddhpuria S, Karimi A, et al. Cholinesterase inhibitors and falls, syncope and injuries in patients with cognitive impairment: a systematic review and meta-analysis. Age Ageing. 2023 Nov 2;52(11):afad205
Review question
In people with cognitive impairment, does treatment with cholinesterase inhibitor drugs affect risks for falls, fainting, or accidental injury?
Background
People with neurocognitive disorders such as Alzheimer’s disease, vascular dementia, Lewy body dementia, Parkinson’s disease dementia, and other types of dementia suffer from cognitive impairment. Cognitive impairment includes problems with thinking, remembering, using language, and making decisions. It may be noticeable but not affect daily living (e.g., mild cognitive impairment), or it may be serious enough to affect daily living (e.g., impairment associated with dementia).
Cholinesterase inhibitor drugs are used to try to prevent or delay worsening of cognitive impairment. However, we don’t know how these drugs affect risk for falls or injury. This review focused on effects of cholinesterase inhibitors on these risks.
How the review was done
Researchers did a systematic review of studies available up to March 2023. They found 53 randomized controlled trials (RCTs) with 25,399 people.
Key features of the studies were:
- people were adults who had cognitive impairment;
- most studies included people with Alzheimer’s disease; other studies included people with vascular dementia, Lewy body dementia, Parkinson’s disease dementia, mild cognitive impairment, traumatic brain injury, or Huntington’s disease;
- cholinesterase inhibitors (donepezil [Aricept®], rivastigmine [Exelon®, Prometax®], or galantamine [Razadyne®, Reminyl®]) were compared with placebo;
- study outcomes included falls, fainting (syncope), fractures, and accidental injury or trauma;
- most studies were done in the community; a few studies were done in long-term care settings; and
- studies lasted for up to 2 years; most lasted for 12 to 24 weeks.
What the researchers found
Compared with placebo, cholinesterase inhibitors:
- reduce risk for falls;
- increase risk for fainting (about 4 more people out of 1000 fainted); and
- do not reduce or increase risks for fractures or accidental injury.
Conclusion
In people with cognitive impairment, cholinesterase inhibitors reduce falls but increase risk for fainting by a small amount compared with placebo. The drugs do not increase the risk for fractures or accidental injury.
Cholinesterase inhibitors* vs placebo in people with cognitive impairment
| Outcomes | Number of trials (number of people) | Rate of events with cholinesterase inhibitors | Rate of events with placebo | Effect of cholinesterase inhibitors |
| Falls | 27 trials (14,541 people) | 5.3% | 6.3% | About 10 fewer people out of 1000 fell |
| Fainting (syncope) | 17 trials (10,727 people) | 1.2% | 0.8% | About 4 more people out of 1000 fainted |
| Fractures | 15 trials (6,809 people) | 1.6% | 1.8% | No difference in effect† |
| Accidental injury | 30 trials (19,417 people) | 4.6% | 5.0% | No difference in effect† |
Related Topics
Glossary
Trouble remembering, learning new things, concentrating, or making decisions that affect everyday life.
A harmless, inactive, and simulated treatment.
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.
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