Cholinesterase inhibitors tied to weight loss in patients with dementia

Last Updated: 2016-06-24

By Marilynn Larkin

NEW YORK (Reuters Health) - Acetylcholinesterase inhibitors (AChEIs), a mainstay of dementia treatment, may double the risk of weight loss in older adults, researchers report.

Both malnutrition and cognitive decline are geriatric syndromes associated with increased risk of premature mortality, according to Dr. Nicola Veronese of the University of Padova, Italy, and colleagues. Some evidence suggests that AChEIs may accelerate weight loss by increasing cholinergic activity in the gastrointestinal system, causing nausea, vomiting, and diarrhea.

Other research suggests that since the drugs improve cognitive status, and good cognitive status is essential to preventing malnutrition, treatment might result in improved nutritional status, the authors explain in the Journal of Neurology, Neurosurgery, and Psychiatry, online June 3.

To investigate the consequences of AChEI treatment in older adults with dementia, the team searched major databases such as PubMed and Scopus from inception through 2015 for longitudinal, open-label and randomized double-blind placebo-controlled trials (RCTs) of AChEIs in patients with dementia reporting nutritional status.

From among 3,551 initial results, the team selected for the meta-analyses 12 open-label trials, nine RCTs and four longitudinal studies that included a total of nearly 10,800 patients.

In the longitudinal studies with a median follow-up of six months, the researchers found a significant cumulative incidence of weight loss between baseline and follow-up evaluation in 5% of participants, a finding that was confirmed in the open-label trials, where 6% experienced significant weight loss between baseline and follow-up.

In the nine RCTs, over a median follow-up of five months, those taking AChEIs more frequently experienced weight loss than participants taking placebo (odds ratio, 2.18; p<0.0001).

"The main finding is that the use of these medications is associated with significant weight loss, independently from the design of the study," Dr. Veronese told Reuters Health by email. "A two-fold increased risk was observed compared to placebo. This suggests that clinicians should carefully evaluate the benefits and risks of prescribing AChEIs, even if the use of other nutritional parameters is needed to confirm our findings."

Dr. Noll Campbell, of the Regenstrief Institute, Indiana University Center for Aging Research and Purdue University College of Pharmacy, Indianapolis, told Reuters Health by email, "Prevalence rates of many adverse events reported by industry-sponsored trials often do not reflect the prevalence in real-world populations, where patients use multiple medications that further increase the rate of adverse events. In these populations, the prevalence of adverse events can be two to three times higher, particularly when considering gastrointestinal adverse events."

"This study further highlights the need for comparative effectiveness/tolerability studies in real-world populations," concluded Dr. Campbell, who was not involved in the study.

No funding source or competing interests were declared.

SOURCE: http://bit.ly/28RQjNG

J Neurol Neurosurg Psychiatry 2016.