Bristol Medical School, University of Bristol, Bristol, UK.
The Research Institute for the Care of Older People (RICE), The RICE Centre Royal United Hospital, Combe Park, Bath, BA1 3NG, UK.
Eur Geriatr Med. 2023 Aug;14(4):721-732. doi: 10.1007/s41999-023-00821-x. Epub 2023 Jul 7.
Cognitive enhancers are the primary pharmacological therapy prescribed to those with dementia, comprising of memantine and the acetylcholinesterase inhibitors (AChEIs). The long-term cognitive and behavioural benefits of these medications, as well as their potential contribution to falls is currently debated, with recent Delphi studies being unable to reach consensus on whether these medications should be deprescribed. In this narrative clinical review, as part of a series on deprescribing in people at risk of falls, we explore the potential falls-related side effects experienced in people taking cognitive enhancers, alongside situations where deprescribing may be appropriate.
We undertook a literature search of PubMed and Google Scholar, using terms capturing falls and cognitive enhancers, as well as consulting the British National Formulary and published Summary of Medicinal Product Characteristics. These searches informed the subsequent clinical review.
Cognitive enhancers should be subject to regular review, including confirmation of appropriate treatment indication, and occurrence of side effects in the context of falls. AChEIs, in particular, are associated with a broad range of side effects that can contribute to increased falls risk. These include bradycardia, syncope and neuromuscular effects. Where these have been identified, deprescribing should be considered, as well as alternative treatment options. Deprescribing studies have shown mixed results, likely due to considerable methodological heterogeneity. Several suggested guidelines exist to aid deprescribing decisions, many of which are highlighted in this review.
The use of cognitive enhancers should be regularly reviewed and decisions to deprescribe made on a case-by-case basis, considering both the risks and benefits of stopping these medications.
认知增强剂是目前用于痴呆症患者的主要药物治疗方法，包括美金刚和乙酰胆碱酯酶抑制剂（AChEIs）。这些药物在认知和行为方面的长期益处，以及它们对跌倒的潜在贡献，目前存在争议，最近的 Delphi 研究未能就这些药物是否应该停药达成共识。在本叙述性临床综述中，作为关于易跌倒人群停药系列的一部分，我们探讨了服用认知增强剂的人可能出现的与跌倒相关的副作用情况，以及可能需要停药的情况。
我们对 PubMed 和 Google Scholar 进行了文献检索，使用了捕捉跌倒和认知增强剂的术语，同时参考了英国国家处方集和已发布的药品特性摘要。这些搜索为随后的临床综述提供了信息。
认知增强剂应定期进行审查，包括确认适当的治疗指征，以及在跌倒的情况下发生副作用的情况。特别是 AChEIs，与广泛的副作用相关，这些副作用可能会增加跌倒风险。这些副作用包括心动过缓、晕厥和神经肌肉效应。如果发现这些副作用，应考虑停药，并考虑替代治疗方案。停药研究结果喜忧参半，可能是由于方法学上存在很大的异质性。有几项建议的指南可以帮助做出停药决策，其中许多在本综述中都有强调。
应定期审查认知增强剂的使用情况，并根据停药的风险和获益情况，逐案做出停药决定。
