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

• Autores: Dae Hyun Kim, Rebecca T. Brown, E. L. Ding, Douglas P. Kiel, Sarah D. Berry
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 59, Nº. 6, 2011, págs. 1019-1031
• Idioma: inglés
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• Resumen

  • 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\u20132.30) than placebo but not with other events (falls: OR=0.88, 95% CI=0.74\u20131.04; fracture: OR=1.39, 95% CI=0.75\u20132.56; accidental injury: OR=1.13, 95% CI=0.87\u20131.45). Memantine use was associated with fewer fractures (OR=0.21, 95% CI=0.05\u20130.85) but not with other events (falls: OR=0.92, 95% CI=0.72\u20131.18; syncope: OR=1.04, 95% CI=0.35\u20133.04; accidental injury: OR=0.80, 95% CI=0.56\u20131.12). 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.