Common Medications for Dementia Could Cause Harmful Weight Loss

SAN FRANCISCO -- August 3, 2015 -- Medications commonly used to treat dementia could result in harmful weight loss, according to a study published in the August issue of the Journal of the American Geriatrics Society.

“This is very relevant to patient care because unintentional weight loss in older adults is associated with many adverse outcomes, including increased rates of institutionalisation and mortality, a decline in functional status, and poorer quality of life,” said lead author Meera Sheffrin, MD, University of California San Francisco School of Medicine, San Francisco, California. “Our study provides evidence in a large, real-world population that cholinesterase inhibitors may contribute to clinically significant weight loss in a substantial proportion of older adults with dementia.”

Cholinesterase inhibitors are marginally beneficial for most patients with dementia and may have serious side effects such as gastrointestinal symptoms. Weight loss also is a significant problem in this patient population and is linked to increased mortality. Data from randomised controlled trials suggests this weight loss may be an under-recognised side effect of cholinesterase inhibitors, but evidence is limited and conflicting.

For the current study, Dr. Sheffrin and colleagues used national VA data from 2007 to 2010 to evaluate patients aged 65 years and older diagnosed with dementia who received a new prescription for a cholinesterase inhibitor or other new chronic medication.

The primary outcome was time to a 4.5-kg weight loss over a 12-month period, as this represents a degree of loss that would be noticed by a clinician and perhaps prompt further action in considering the causes and potential treatments.

A total of 1,188 patients started on cholinesterase inhibitors were matched to 2,189 patients started on other medications. At 12 months, 78% were still on the inhibitors, compared with 66% for other medications. About 29.3% of patients on the inhibitors experienced significant weight loss, compared with 22.8% of non-users.

These results demonstrated that patients started on the medications had a higher risk of clinically significant weight loss over a 12-month period compared with matched controls. Specifically, 1 out of every 21 patients treated experienced at least a 4.5-kg weight loss.

Further research is needed to validate these findings and address study limitations, including if there is a specific subgroup in which starting cholinesterase inhibitors had a higher risk of weight loss, as this study may have been underpowered to find those differences. The sample also included mainly older male veterans, so the generalizability of the findings to women is uncertain, the researchers said.

“Clinicians should take into account the risk of weight loss when weighing the risks and benefits of prescribing cholinesterase inhibitors in patients with dementia,” the authors wrote. “In addition, clinicians should monitor for weight loss if these medications are prescribed and consider discontinuing cholinesterase inhibitors if significant weight loss occurs.”

SOURCE: University of California, San Francisco
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