Cholinesterase inhibitors and falls, syncope and injuries in patients with cognitive impairment: a systematic review and meta-analysis.

Autor:	Ahuja M; Department of Medicine, McMaster University, Hamilton, Ontario, Canada., Siddhpuria S; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada., Karimi A; Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA., Lewis K; Department of Medicine, McMaster University, Hamilton, Ontario, Canada., Wong E; Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Canada., Lee J; Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Canada., Reppas-Rindlisbacher C; Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Canada., Sood E; Faculty of Science, Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada., Gabor C; Hamilton Health Sciences, Hamilton, Ontario, Canada., Patterson C; Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Canada.
Jazyk:	angličtina
Zdroj:	Age and ageing [Age Ageing] 2023 Nov 02; Vol. 52 (11).
DOI:	10.1093/ageing/afad205
Abstrakt:	Background: Cholinesterase inhibitors are commonly used to treat patients with neurocognitive disorders, who often have an elevated risk of falling. Effective use of these medications requires a thoughtful assessment of risks and benefits. Objective: To provide an update on previous reviews and determine the association between cholinesterase inhibitors and falls, syncope, fracture and accidental injuries in patients with neurocognitive disorders. Methods: Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature and AgeLine were systematically searched through March 2023 to identify all randomised controlled trials of cholinesterase inhibitors (donepezil, galantamine, rivastigmine) in patients with cognitive impairment. Corresponding authors were contacted for additional data necessary for meta-analysis. Inclusion criteria consisted of adults ≥19 years, with a diagnosis of dementia, Parkinson's disease, mild cognitive impairment or traumatic brain injury. Data were extracted in duplicate for the aforementioned primary outcomes and all outcomes were analysed using random-effects meta-analysis. Results: Fifty three studies (30 donepezil, 14 galantamine, 9 rivastigmine) were included providing data on 25, 399 patients. Cholinesterase inhibitors, compared to placebo, were associated with reduced risk of falls (risk ratio [RR] 0.84 [95% confidence interval [CI] = 0.73-0.96, P = 0.009]) and increased risk of syncope (RR 1.50 [95% CI = 1.02-2.21, P = 0.04]). There was no association with accidental injuries or fractures. Conclusion: In patients with neurocognitive disorders, cholinesterase inhibitors were associated with decreased risk of falls, increased risk of syncope and no association with accidental trauma or fractures. These findings will help clinicians better evaluate risks and benefits of cholinesterase inhibitors. (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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