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Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: a systematic review and meta-analysis.

Authors
  • Soysal, Pinar1
  • Isik, Ahmet Turan1
  • Stubbs, Brendon2, 3, 4
  • Solmi, Marco5, 6
  • Volpe, Marco7
  • Luchini, Claudio8, 9
  • D'Onofrio, Grazia10
  • Pilotto, Alberto11
  • Manzato, Enzo12
  • Sergi, Giuseppe12
  • Schofield, Patricia4
  • Veronese, Nicola12
  • 1 Faculty of Medicine, Department of Geriatric Medicine, Center for Aging Brain and Dementia, Dokuz Eylul University, Izmir, Turkey.
  • 2 Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.
  • 3 Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
  • 4 Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK.
  • 5 Department of Neurosciences, University of Padova, Padova, Italy.
  • 6 Psychiatry Unit, Monselice, Italy.
  • 7 Neurology Division, Padova, Italy.
  • 8 APSS Trento, Surgical Pathology Unit, Santa Chiara Hospital, Trento, Italy.
  • 9 Department of Pathology, University of Verona, Verona, Italy.
  • 10 Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
  • 11 Department of Ortho Geriatrics, Rehabilitation and Stabilization, Frailty Area, E.O. Galliera Hospital, NR-HS, Genoa, Italy.
  • 12 Department of Medicine, Geriatrics Section, University of Padova, Padova, Italy.
Type
Published Article
Journal
Journal of Neurology Neurosurgery & Psychiatry
Publisher
BMJ
Publication Date
December 2016
Volume
87
Issue
12
Pages
1368–1374
Identifiers
DOI: 10.1136/jnnp-2016-313660
PMID: 27261502
Source
Medline
Keywords
License
Unknown

Abstract

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.

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