Abstract
Aim
To summarize the falls-related risks of cognitive enhancing medications used to treat neurodegenerative conditions. To assist the clinician in considering the appropriateness of prescribing a cognitive enhancer in an older person at risk of falls and explore the factors that should be considered when reviewing the ongoing use of these medications.
Findings
Cognitive enhancer use is associated with multiple fall-related side effects, particularly in the initial weeks of administration and up-titration. Acetylcholinesterase inhibitors and memantine differ in their fall-related side effect profiles. Cognitive enhancers can contribute to falls through precipitating cardiac, sleep, neurological (e.g. seizure), extrapyramidal, bladder and/or neuro-psychiatric side effects. Cognitive enhancers should be subject to frequent medication review, including appropriate treatment indication and occurrence of side effects. Several suggested guidelines exist to aid deprescribing decisions, however, these are based on a relatively small number of focused clinical trials.
Message
An individualised approach should be taken when considering whether cognitive enhancer therapy is still appropriate in older adults at risk of falling. Clinicians should consider the plethora of risks associated with (de-) prescribing these medications.
To summarize the falls-related risks of cognitive enhancing medications used to treat neurodegenerative conditions. To assist the clinician in considering the appropriateness of prescribing a cognitive enhancer in an older person at risk of falls and explore the factors that should be considered when reviewing the ongoing use of these medications.
Findings
Cognitive enhancer use is associated with multiple fall-related side effects, particularly in the initial weeks of administration and up-titration. Acetylcholinesterase inhibitors and memantine differ in their fall-related side effect profiles. Cognitive enhancers can contribute to falls through precipitating cardiac, sleep, neurological (e.g. seizure), extrapyramidal, bladder and/or neuro-psychiatric side effects. Cognitive enhancers should be subject to frequent medication review, including appropriate treatment indication and occurrence of side effects. Several suggested guidelines exist to aid deprescribing decisions, however, these are based on a relatively small number of focused clinical trials.
Message
An individualised approach should be taken when considering whether cognitive enhancer therapy is still appropriate in older adults at risk of falling. Clinicians should consider the plethora of risks associated with (de-) prescribing these medications.
| Original language | English |
|---|---|
| Pages (from-to) | 721-732 |
| Number of pages | 12 |
| Journal | European Geriatric Medicine |
| Volume | 14 |
| Issue number | 4 |
| Early online date | 7 Jul 2023 |
| DOIs | |
| Publication status | Published - 1 Aug 2023 |
Bibliographical note
Funding Information:G.E.P. was supported by the Biotechnology and Biological Sciences Research Council funded South West Biosciences Doctoral Training Partnership [BB/M009122/1]. Matthew Smith is funded as part of a programme grant from the Gatsby Charitable Foundation.
Publisher Copyright:
© 2023, The Author(s).