Dementia Patients on Cholinesterase Inhibitors Risk Substantial Weight Loss

Meera Sheffrin MD Geriatrics Fellow Division of Geriatrics | Department of Medicine San Francisco VA Medical Center University of California, San Francisco MedicalResearch.com Interview with:
Meera Sheffrin MD
Geriatrics Fellow
Division of Geriatrics | Department of Medicine
San Francisco VA Medical Center
University of California, San Francisco

Medical Research: What is the background for this study? What are the main findings?

Dr. Sheffrin: The main drug treatments for dementia are a class of medications called cholinesterase inhibitors. They have only modest effects on cognition and function in most patients, but since they are one of the few available treatments for dementia and thus very commonly prescribed. However,they are known to cause GI side effects (nausea, vomiting, diarrhea, and anorexia) in many patients when first started. It is plausible they could also caust weight loss, espeically considering they cause nausea and anorexia. However, the data on weight loss from randomized controlled trials is very limited and inconclusive, so we did a very large observational study in a real-world of the VA national healthcare system who were newly started on these medications, to see if they were associated with weight loss.

We found that patient with dementia started on cholinesterase inhibitors had a substantially higher risk of clinically significant weight loss over a 12-month period compared to matched controls.

1,188 patients started on cholinesterase inhibitors were matched to 2,189 similar patients who were started on other new chronic medications. The primary outcome was time to a 10-pound weight loss over a 12-month period, as this represents a degree of loss that would be clinically meaningful – not only noticed by a clinician but would perhaps prompt further action in considering the causes of the weight loss and medical work-up.

We found that starting cholinesterase inhibitors was associated with a 24% greater risk of developing weight loss. Overall, 29% of patients started on cholinesterase inhibitors experienced a weight loss of 10 pounds or more, compared with 23% of the control group. This corresponds to a number needed to harm of 21 over 1 year; meaning only 21 patients need to be treated with a cholinesterase inhibitor over the course of a year for one patient to experience a 10 pound weight loss.

Medical Research: What should clinicians and patients take away from your report?

Dr. Sheffrin: Patients with dementia started on cholinesterase inhibitors had a substantially higher risk of experiencing a clinically significant weight loss. The decision to prescribe a cholinesterase inhibitor is a complex one- clinicians and should take into account the modest benefits and possible harms, including weight loss, that are associated with these medications.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Sheffrin: Further research should be done to determine if they are particular groups of patients (women, frail patients) who are more likely to experience the adverse effect of weight loss after starting cholinesterase inhibitors.

Citation:

Weight Loss Associated with Cholinesterase Inhibitors in Individuals with Dementia in a National Healthcare System

Meera Sheffrin MD Yinghui Miao MPH W. John Boscardin PhD1,2 and Michael A. Steinman MD1

Article first published online: 3 AUG 2015

DOI: 10.1111/jgs.13511 J Am Geriatr Soc 2015.

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Meera Sheffrin MD (2015). Dementia Patients on Cholinesterase Inhibitors Risk Substantial Weight Loss 

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