Alzheimer's, Dementia & Mental Health
Senior Citizens Taking Dementia Drugs Have 49
Percent Greater Risk of Permanent Pacemakers
Drugs used for Alzheimer’s disease and other
dementias also increase hip fracture risk by 18% in Canadian study
May 28, 2009 - Side effects associated with several
drugs commonly prescribed for Alzheimer’s disease and related dementias
may be putting elderly Canadians at risk, says Queen's University
Geriatrics professor Sudeep Gill.
Cholinesterase inhibitors (Aricept, Exelon and
Reminyl) are often prescribed for people with dementias because they
increase the level of a chemical in the brain that seems to help memory.
Although such drugs are known to provoke slower heart rates and fainting
episodes, the magnitude of these risks has not been clear until now.
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"This is very troubling, because the drugs are
marketed as helping to preserve memory and improve function," says Dr.
Gill, who is an Ontario Ministry of Health and Long-term Care Career
Scientist, working at Providence Care's St. Mary's of the Lake Hospital
in Kingston. "But for a subset of people, the effect appears to be the
exact opposite."
In a large study using province-wide data, Dr. Gill
and his colleagues discovered that people who used cholinesterase
inhibitors were hospitalized for fainting almost twice as often as
people with dementia who did not receive these drugs.
Experiencing a slowed heart-rate was 69 per cent
more common amongst cholinesterase inhibitor users. In addition, people
taking the dementia drugs had a 49 per cent increased chance of having
permanent pacemakers implanted and an 18 per cent increased risk of hip
fractures.
Unfortunately, Dr. Gill continues, this class of
drugs is one of the few effective dementia treatments available today.
Acknowledging that these drugs do have an important role in the
management of dementia, he suggests that people who are already at a
higher risk (for example, those who have had previous episodes of
fainting or slowed heart rate) may want to ask their doctors to reassess
the value of taking the drugs.
Slowing of the heart rate from cholinesterase
inhibitors, if significant, may cause a person to faint and suffer
fall-related injuries such as a broken hip - often debilitating and
sometimes fatal for seniors. However, many physicians aren't aware of
the connection between these problems and the dementia drugs, Dr. Gill
notes.
If the association with dementia drugs is not
identified, people who faint may be prescribed a permanent pacemaker: an
invasive procedure that can involve serious complications for seniors.
Both the injuries incurred from falling and the risks from pacemaker
implants are "downstream consequences" of not recognizing this
drug-induced phenomenon.
"This study does not suggest that dementia patients
shouldn't take these drugs," says Dr. Gill. "What's critical is that
patients, caregivers and physicians be aware of the potential side
effects, and weigh these risks carefully against the potential for
beneficial effects."
The findings are published in the journal,
Archives of Internal Medicine.
Scientists from the Institute for Clinical Evaluative Sciences, the
University of Toronto and Harvard University are also on the research
team.
The study uses data housed at the Institute for
Clinical Evaluative Sciences (ICES). Ontario's first satellite unit of
ICES was established at Queen's in 2007 to provide university
researchers with electronic access to Ontario health datasets and
population registries by secured and encrypted lines. Areas of focus at
Queen's include cancer, pharmacological studies and dementia.
