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J Am Geriatr Soc. 2011 Jun;59(6):1019-31. doi: 10.1111/j.1532-5415.2011.03450.x. Epub 2011 Jun 7.

Dementia medications and risk of falls, syncope, and related adverse events: meta-analysis of randomized controlled trials.

Author information

  • 1Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA. dkim2@bidmc.harvard.edu

Abstract

OBJECTIVES:

To evaluate the effect of cholinesterase inhibitors (ChEIs) and memantine on the risk of falls, syncope, and related events, defined as fracture and accidental injury.

DESIGN:

Meta-analysis of randomized controlled trials that were identified from MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (no language restriction, through July 2009), and manual search.

SETTING:

Community and nursing homes.

PARTICIPANTS:

Participants in fifty-four placebo-controlled randomized trials and extension studies of ChEIs and memantine that reported falls, syncope, and related events in cognitively impaired older adults.

MEASUREMENTS:

Falls, syncope, fracture, and accidental injury.

RESULTS:

ChEI use was associated with greater risk of syncope (odds ratio (OR)=1.53, 95% confidence interval (CI)=1.02-2.30) than placebo but not with other events (falls: OR=0.88, 95% CI=0.74-1.04; fracture: OR=1.39, 95% CI=0.75-2.56; accidental injury: OR=1.13, 95% CI=0.87-1.45). Memantine use was associated with fewer fractures (OR=0.21, 95% CI=0.05-0.85) but not with other events (falls: OR=0.92, 95% CI=0.72-1.18; syncope: OR=1.04, 95% CI=0.35-3.04; accidental injury: OR=0.80, 95% CI=0.56-1.12). There was no differential effect according to type and severity of cognitive impairment, residential status, or length of follow-up, although because of underreporting and small number of events, a potential benefit or risk cannot be excluded.

CONCLUSION:

ChEIs may increase the risk of syncope, with no effects on falls, fracture, or 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.

© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

PMID:
21649634
[PubMed - indexed for MEDLINE]
PMCID:
PMC3260523
Free PMC Article
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