Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: a systematic review and meta-analysis.
We conducted a systematic review and meta-analysis investigating the influence of acetylcholinesterase inhibitors (AChEIs) therapy on nutritional status and weight across observational and interventional studies. Two authors searched major electronic databases from inception until 10/14/2015 for longitudinal, open-label and randomised double-blind placebo controlled (randomised controlled trials (RCTs)) studies of AChEIs in patients with dementia reporting nutritional status outcome data. Out of 3551 initial hits, 25 studies (12 open-label trials, 9 RCTs and 4 longitudinal studies) including 10 792 patients with dementia were meta-analysed. In longitudinal studies (median follow-up 6 months), a significant cumulative incidence of weight loss between baseline and follow-up evaluation was observed (studies=2; 5%; 95% CI 1% to 34%, p<0.0001; I2=95%). These findings were confirmed in open-label trials (6%; 95% CI 4% to 7%, p<0.0001; I2=78%). In 9 RCTs (median follow-up 5 months), those taking AChEIs more frequently experienced weight loss than participants taking placebo (OR=2.18; 95% CI 1.50 to 3.17, p<0.0001; I2=29%). AChEIs therapy contributes to weight loss in patients with dementia, with a 2-fold increased risk observed in the meta-analysis of RCTs. Clinicians should carefully consider the benefit and risk of prescribing AChEIs. Nutritional status should be routinely evaluated in patients with dementia treated with AChEIs.
Faculty of Medicine, Department of Geriatric Medicine, Center for Aging Brain and Dementia, Dokuz Eylul University, Izmir, Turkey.
Pinar
P
Soysal
Faculty of Medicine, Department of Geriatric Medicine, Center for Aging Brain and Dementia, Dokuz Eylul University, Izmir, Turkey.
Ahmet Turan
AT
Isik
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.|Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK.|Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK.
Brendon
B
Stubbs
Department of Neurosciences, University of Padova, Padova, Italy.|Psychiatry Unit, Monselice, Italy.
Marco
M
Solmi
Neurology Division, Padova, Italy.
Marco
M
Volpe
APSS Trento, Surgical Pathology Unit, Santa Chiara Hospital, Trento, Italy.|Department of Pathology, University of Verona, Verona, Italy.
Claudio
C
Luchini
Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
Grazia
G
D'Onofrio
Department of Ortho Geriatrics, Rehabilitation and Stabilization, Frailty Area, E.O. Galliera Hospital, NR-HS, Genoa, Italy.
Alberto
A
Pilotto
Department of Medicine, Geriatrics Section, University of Padova, Padova, Italy.
Enzo
E
Manzato
Department of Medicine, Geriatrics Section, University of Padova, Padova, Italy.
Giuseppe
G
Sergi
Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK.
Patricia
P
Schofield
Department of Medicine, Geriatrics Section, University of Padova, Padova, Italy.
Nicola
N
Veronese
D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D015431:Weight Loss / Q000187:drug effects*
D002800:Cholinesterase Inhibitors
ALZHEIMER'S DISEASE; DEMENTIA; GERIATRICS; META-ANALYSIS