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Review: in people with dementia, cholinesterase inhibitors may increase syncope and memantine may reduce fractures

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Question

Question

What is the effect of dementia medications (cholinesterase inhibitors and memantine) on the risk of falls and fall-related adverse events in older adults with mild cognitive impairment or dementia?

Outcomes

Falls; fall-related adverse events (syncope, fracture or accidental injury).

Methods

Design

Systematic review with meta-analysis.

Data sources

MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched from inception to July 2009 for randomised controlled trials (RCTs). Unpublished safety data from RCTs were identified by searching pharmaceutical clinical trial registries, medical and safety review documents from the US Food and Drug Administration and hand searching reference lists of review articles.

Study selection and analysis

A minimum of two reviewers appraised the studies and selected placebo-controlled RCTs of memantine or any cholinesterase inhibitor (ChEIs: donepezil, galantamine, rivastigmine or tacrine) in adults with a diagnosis of mild cognitive impairment, Alzheimer's disease, mixed dementia, vascular dementia, dementia with Lewy bodies, Parkinson's disease with dementia or frontotemporal dementia. Eligible studies were examined for data on falls, syncope, fracture or accidental injury; …

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