Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 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

Dae Hyun Kim  1 , Rebecca T Brown, Eric L Ding, Douglas P Kiel, Sarah D Berry
Affiliations
Meta-Analysis

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

Dae Hyun Kim et al. J Am Geriatr Soc. 2011 Jun.

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Study Selection.
Abbreviation: RCT, randomized controlled trial. * Not mutually exclusive.
Figure 2
Figure 2. Meta-Analysis of Cholinesterase Inhibitors and Falls, Syncope, and Related Events.*†
Abbreviations: CI, confidence interval; Don, donepezil; Gal, galantamine; OR, odds ratio; Riv, rivastigmine; Tac, tacrine. * Pooled odds ratio and 95% confidence interval of each study are represented by a square and a horizontal line, respectively. The size of a square is proportional to the weight of the study. † I2 measures the proportion of heterogeneity in individual studies that cannot be explained by chance.
Figure 3
Figure 3. Meta-Analysis of Memantine and Falls, Syncope, and Related Events.*†
Abbreviations: CI, confidence interval; OR, odds ratio. * Pooled odds ratio and 95% confidence interval of each study are represented by a square and a horizontal line, respectively. The size of a square is proportional to the weight of the study. † I2 measures the proportion of heterogeneity in individual studies that cannot be explained by chance.
See this image and copyright information in PMC

Comment in

References

    1. van Dijk PT, Meulenberg OG, van de Sande HJ, et al. Falls in dementia patients. Gerontologist. 1993;33:200–204. - PubMed
    1. Morris JC, Rubin EH, Morris EJ, et al. Senile dementia of the Alzheimer's type: An important risk factor for serious falls. J Gerontol. 1987;42:412–417. - PubMed
    1. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701–1707. - PubMed
    1. Stevens JA, Corso PS, Finkelstein EA, et al. The costs of fatal and non-fatal falls among older adults. Inj Prev. 2006;12:290–295. - PMC - PubMed
    1. Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med. 1997;337:1279–1284. - PubMed

Publication types

MeSH terms