PDF(Pubmed)
Abstract：
Cognitive enhancers are the primary pharmacological therapy prescribed to those with dementia, comprising of memantine and the acetylcholinesterase inhibitors (AChEIs). The long-term cognitive and behavioural benefits of these medications, as well as their potential contribution to falls is currently debated, with recent Delphi studies being unable to reach consensus on whether these medications should be deprescribed. In this narrative clinical review, as part of a series on deprescribing in people at risk of falls, we explore the potential falls-related side effects experienced in people taking cognitive enhancers, alongside situations where deprescribing may be appropriate.
We undertook a literature search of PubMed and Google Scholar, using terms capturing falls and cognitive enhancers, as well as consulting the British National Formulary and published Summary of Medicinal Product Characteristics. These searches informed the subsequent clinical review.
Cognitive enhancers should be subject to regular review, including confirmation of appropriate treatment indication, and occurrence of side effects in the context of falls. AChEIs, in particular, are associated with a broad range of side effects that can contribute to increased falls risk. These include bradycardia, syncope and neuromuscular effects. Where these have been identified, deprescribing should be considered, as well as alternative treatment options. Deprescribing studies have shown mixed results, likely due to considerable methodological heterogeneity. Several suggested guidelines exist to aid deprescribing decisions, many of which are highlighted in this review.
The use of cognitive enhancers should be regularly reviewed and decisions to deprescribe made on a case-by-case basis, considering both the risks and benefits of stopping these medications.
We undertook a literature search of PubMed and Google Scholar, using terms capturing falls and cognitive enhancers, as well as consulting the British National Formulary and published Summary of Medicinal Product Characteristics. These searches informed the subsequent clinical review.
Cognitive enhancers should be subject to regular review, including confirmation of appropriate treatment indication, and occurrence of side effects in the context of falls. AChEIs, in particular, are associated with a broad range of side effects that can contribute to increased falls risk. These include bradycardia, syncope and neuromuscular effects. Where these have been identified, deprescribing should be considered, as well as alternative treatment options. Deprescribing studies have shown mixed results, likely due to considerable methodological heterogeneity. Several suggested guidelines exist to aid deprescribing decisions, many of which are highlighted in this review.
The use of cognitive enhancers should be regularly reviewed and decisions to deprescribe made on a case-by-case basis, considering both the risks and benefits of stopping these medications.
摘要：
目的：认知促进剂是治疗痴呆患者的主要药物，由美金刚和乙酰胆碱酯酶抑制剂(AChEI)组成。这些药物的长期认知和行为益处，以及它们对跌倒的潜在贡献目前正在争论中，由于最近的Delphi研究无法就是否应停用这些药物达成共识。在这篇叙述性的临床综述中，作为一系列关于对有跌倒风险的人开药的一部分，我们探索了服用认知增强剂的人所经历的潜在跌倒相关副作用，以及可能适合开药的情况。
方法：我们对PubMed和GoogleScholar进行了文献检索，使用捕获跌倒和认知增强剂的术语，以及咨询英国国家处方集和出版的药品特征摘要。这些搜索为随后的临床审查提供了信息。
结果：认知增强剂应接受定期审查，包括确认适当的治疗指征，以及在跌倒背景下副作用的发生。ACHEIs,特别是,与广泛的副作用有关，这些副作用可能导致跌倒风险增加。这些包括心动过缓,晕厥和神经肌肉的影响。在这些被识别的地方，应该考虑取消处方，以及替代治疗方案。开处方的研究表明结果好坏参半，可能是由于相当大的方法论异质性。有几个建议的指导方针来帮助取消处方的决定，其中许多在这次审查中得到强调。
结论：应定期审查认知增强剂的使用情况，并根据具体情况做出停用药物的决定，同时考虑停止这些药物的风险和益处。
方法：我们对PubMed和GoogleScholar进行了文献检索，使用捕获跌倒和认知增强剂的术语，以及咨询英国国家处方集和出版的药品特征摘要。这些搜索为随后的临床审查提供了信息。
结果：认知增强剂应接受定期审查，包括确认适当的治疗指征，以及在跌倒背景下副作用的发生。ACHEIs,特别是,与广泛的副作用有关，这些副作用可能导致跌倒风险增加。这些包括心动过缓,晕厥和神经肌肉的影响。在这些被识别的地方，应该考虑取消处方，以及替代治疗方案。开处方的研究表明结果好坏参半，可能是由于相当大的方法论异质性。有几个建议的指导方针来帮助取消处方的决定，其中许多在这次审查中得到强调。
结论：应定期审查认知增强剂的使用情况，并根据具体情况做出停用药物的决定，同时考虑停止这些药物的风险和益处。
