Calvin Hirsch, MD
In older persons with dementia, is use of cholinesterase inhibitors associated with increased risk for syncope and its consequences?
Retrospective cohort study with mean follow-up of approximately 10 months.
Population-based study in Ontario, Canada.
81 302 community-dwelling persons ≥ 66 years of age (mean age 80 y, 62% women) who had been diagnosed with dementia and had not been hospitalized for syncope in the previous year. 19 803 patients (drug cohort) were new users of cholinesterase inhibitors (donepezil, galantamine, or rivastigmine), and 61 499 patients (control cohort) had not received a prescription for a cholinesterase inhibitor in the previous year. The control cohort was matched to the drug cohort by year and quarter of cohort entry.
Use of a cholinesterase inhibitor. Patients were censored if they stopped using the drug (drug cohort) or started using the drug (control cohort).
First hospital visit (emergency department or admission) for syncope, bradycardia or complete atrioventricular block, permanent pacemaker insertion, or hip fracture.
All outcomes were more frequent in patients who received prescriptions for a cholinesterase inhibitor than in those who did not (Table).
In older persons with dementia, new use of cholinesterase inhibitors was associated with increased risk for syncope and its consequences.
Association between new use of cholinesterase inhibitors and first hospital visit for syncope or its consequences in older persons with dementia
*Adjusted for such other risk factors as age, sex, use of antiarrhythmic drugs, presence of atrial fibrillation, previous pacemaker insertion, Charlson comorbidity index score, and history of hip fracture.
†Excluding patients with previous pacemaker insertion.
Hirsch C. Cholinesterase inhibitors were associated with increased risk for syncope and its consequences in older persons with dementia. Ann Intern Med. ;151:JC3–13. doi: 10.7326/0003-4819-151-6-200909150-02013
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Published: Ann Intern Med. 2009;151(6):JC3-13.
Dementia, Geriatric Medicine, Neurology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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