Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
Age Ageing. 2023 Nov 2;52(11). doi: 10.1093/ageing/afad205.
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.
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.
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.
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.
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.
胆碱酯酶抑制剂常用于治疗神经认知障碍患者，这些患者常存在较高的跌倒风险。为了安全有效地使用这些药物，需要仔细评估其风险和获益。
对之前的综述进行更新，明确神经认知障碍患者使用胆碱酯酶抑制剂（多奈哌齐、加兰他敏、利斯的明）与跌倒、晕厥、骨折和意外伤害之间的相关性。
系统检索了 Embase、MEDLINE、Cochrane 对照试验中心注册库、护理学和联合健康文献累积索引和 AgeLine 数据库，检索时间截至 2023 年 3 月，以确定所有关于胆碱酯酶抑制剂（多奈哌齐、加兰他敏、利斯的明）治疗认知障碍患者的随机对照试验。对无法获取的研究数据，通过联系相应作者获取。纳入标准为年龄≥19 岁，患有痴呆、帕金森病、轻度认知障碍或创伤性脑损伤。对上述主要结局和所有结局均采用随机效应荟萃分析进行数据提取。
共纳入 53 项研究（多奈哌齐 30 项、加兰他敏 14 项、利斯的明 9 项），共计 25399 例患者。与安慰剂相比，胆碱酯酶抑制剂可降低跌倒风险（风险比 [RR] 0.84 [95%置信区间 [CI] 0.73-0.96，P=0.009]），增加晕厥风险（RR 1.50 [95% CI 1.02-2.21，P=0.04]）。但与意外伤害或骨折无关。
在神经认知障碍患者中，胆碱酯酶抑制剂可降低跌倒风险，增加晕厥风险，与意外伤害或骨折无关。这些发现将有助于临床医生更好地评估胆碱酯酶抑制剂的风险和获益。
