title: Dementia medications and risk of falls, syncope, and related adverse events: meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Community and nursing homes.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA. dkim2@bidmc.harvard.edu
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Kim
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Brown
authors.forename: Eric L
authors.initials: EL
authors.lastname: Ding
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Kiel
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Berry
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D003072:Cognition Disorders / Q000188:drug therapy*; D003704:Dementia / Q000188:drug therapy* / Q000453:epidemiology; D015259:Dopamine Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006801:Humans; D008297:Male; D008559:Memantine / Q000009:adverse effects* / Q000627:therapeutic use; D018697:Nootropic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D012307:Risk Factors; D013575:Syncope / Q000139:chemically induced* / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology
chemical_list: D002800:Cholinesterase Inhibitors; D015259:Dopamine Agents; D018697:Nootropic Agents; D008559:Memantine