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Cholinesterase inhibitors increase risk for weight loss among individuals with dementia

Older individuals with dementia taking cholinesterase inhibitors were more likely to experience 10-pound weight loss after 12 months than peers taking other medications, according to study findings in the Journal of the American Geriatrics Society.

“Weight loss and anorexia are reported adverse effects of cholinesterase inhibitors that may be under-recognized. This is an important problem because involuntary weight loss has been associated with mortality in older adults, and individuals with dementia may represent an additionally vulnerable population, but much is unknown about cholinesterase inhibitors and their effect on weight,” study researcher Meera Sheffrin, MD, of the University of California, San Francisco, and colleagues wrote. “There is inconsistent evidence from clinical trials that weight loss occurs in some individuals started on cholinesterase inhibitors, the available data provide highly variable information on the degree of weight loss experienced, and many studies were underpowered to provide meaningful data about this outcome.”

Meera Sheffrin

Researchers retrospectively assessed weight loss among individuals aged 65 years and older with diagnosed dementia who received a new prescription for a cholinesterase inhibitor or other new chronic medication from 2007 to 2010. The study cohort included 1,188 individuals taking cholinesterase inhibitors and 2,189 taking other medications. The primary study outcome was time to 10-pound weight loss over 12 months.

At 12 months, 29.3% of individuals taking cholinesterase inhibitors had experienced weight loss compared with 22.8% of individuals taking other medications, and thus, had a higher risk for weight loss at 12 months (HR = 1.23; 95% CI, 1.07-1.41).

This corresponded with a number needed to harm of 21.2 (95% CI, 12.5-71.4) over 1 year, according to researchers.

“These findings are important for clinical practice. This degree of weight loss, 10 pounds or greater, is clinically significant in this vulnerable population and may lead to institutionalization and mortality,” Sheffrin and colleagues wrote. “Clinicians should take into account the risk of weight loss when weighing the risks and benefits of prescribing cholinesterase inhibitors in participants with dementia and should monitor for weight loss if these medications are prescribed and consider discontinuing cholinesterase inhibitors if significant weight loss occurs.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.