title: Medication for Alzheimer's disease and associated fall hazard: a retrospective cohort study from the Alzheimer's Disease Neuroimaging Initiative.
abstract: BACKGROUND
  Falls are common in the elderly, especially in those with cognitive impairment. The elderly are often treated with several medications, which may have both beneficial and deleterious effects. The use and type of medication in Alzheimer's disease (AD) patients and association with falls is limited.
  
  
  OBJECTIVE
  We examined the association between falls and medication use in the Alzheimer's Disease Neuroimaging Initiative (ADNI).
  
  
  METHODS
  Diagnosis, demographics, medication use, apolipoprotein E4 allele status and functional activity level at baseline were gathered for 810 participants enrolled in the ADNI, including healthy controls and subjects with mild cognitive impairment or Alzheimer's. Reports detailing adverse event falls were tabulated. Baseline characteristics were compared between subjects with and without one or more falls. Cox proportional hazards models were conducted to evaluate the association between subject characteristics and hazard of the first fall.
  
  
  RESULTS
  Age (p < 0.0001), Functional Activities Questionnaire (p = 0.035), Beers List (p = 0.0477) and medications for treating cognitive symptoms of Alzheimer's (p = 0.0019) were associated with hazard of fall in the univariate model. In the final multivariate model, after adjusting for covariates, Alzheimer's medication use (p = 0.0005) was associated with hazard of fall. Medication was changed by the clinician after an adverse fall event in 9% of the falls. About 7% of the falls were reported as serious adverse events and 6% were reported to be severe.
  
  
  CONCLUSIONS
  We found a significant association between the use of symptomatic medication treating cognitive symptoms in AD and hazard of fall after adjusting for age and Beers List medication use. Additional pharmacovigilance of the association between falls and Alzheimer's medication use is warranted.
authors.affiliation: Department of Neurology, Hines VA Medical Center, 5000 South 5th Avenue, Hines, IL, 60141, USA, nue2you@gmail.com.
authors.forename: Noam U
authors.initials: NU
authors.lastname: Epstein
authors.forename: Rong
authors.initials: R
authors.lastname: Guo
authors.forename: Martin R
authors.initials: MR
authors.lastname: Farlow
authors.forename: Jaswinder P
authors.initials: JP
authors.lastname: Singh
authors.forename: Morris
authors.initials: M
authors.lastname: Fisher
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D000544:Alzheimer Disease / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D053327:Apolipoprotein E4 / Q000235:genetics; D016022:Case-Control Studies; D002800:Cholinesterase Inhibitors / Q000009:adverse effects; D003072:Cognition Disorders / Q000235:genetics / Q000628:therapy; D060825:Cognitive Dysfunction / Q000150:complications / Q000235:genetics; D006801:Humans; D008559:Memantine / Q000009:adverse effects; D015999:Multivariate Analysis; D059906:Neuroimaging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D053327:Apolipoprotein E4; D002800:Cholinesterase Inhibitors; D008559:Memantine