Abstract
Drugs for degenerative neurologic conditions like antiparkinson medications, cholinesterase inhibitors, and memantine are used for symptomatic treatment of Parkinson’s disease and for stabilization of decline or to slow progression of dementias, respectively. Since these drugs are not curative, knowing their risks is essential. In a population at higher risk of falls, does the use of these medications further increase that risk? A literature review showed a number of studies that included cholinesterase inhibitors demonstrated mixed results on their association with falls. Studies were often retrospective in nature and failed to account for confounders, limiting their interpretation. There was paucity of studies on memantine, but the available literature failed to show an association with falls. The small number of studies on antiparkinson medication showed an association between higher levodopa dose, but it remains unclear if this could be accounted for by the underlying disease duration and severity. At present, it remains essential to address the numerous fall-related risk factors in these high-risk populations. Although some literature has suggested an association between falls and these medications, it is arguably an association influenced or directly caused by the disease itself. Further studies of higher quality are needed to clarify this issue.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsAbbreviations
- AD:
-
Alzheimer’s disease
- CI:
-
Cholinesterase inhibitor; confidence interval
- COMT:
-
Catechol-O-methyltransferase
- HR:
-
Hazard ratio
- LED:
-
Levodopa equivalent dosing
- MAO:
-
Monoamine oxidase
- OR:
-
Odds ratio
- PD:
-
Parkinson’s disease
- RCT:
-
Randomized controlled trial
References
Allcock LM, Rowan EN, Steen IN, Wesnes K, Kenny RA, Burn DJ (2009) Impaired attention predicts falling in Parkinson’s disease. Parkinsonism Relat Disord 15(2):110–115
Allen NE, Schwarzel AK, Canning CG (2013) Recurrent falls in Parkinson’s disease: a systematic review. Park Dis 2013:906274. doi:10.1155/2013/906274
Almeida LRS, Valença GT, Negreiros NN, Pinto EB, and Oliveira-Filho J (2014) Recurrent falls in people with Parkinson’s disease without cognitive impairment: focusing on modifiable risk factors. Park Dis. Article ID 432924. doi:10.1155/2014/432924
Ashburn A, Stack E, Pickering RM, Ward CD (2001) A community-dwelling sample of people with Parkinson’s disease characteristics of fallers and non-fallers. Age Ageing 30:47–52
Assal F, Allali G, Kressig RW et al (2008) Galantamine improves gait performance in patients with Alzheimer’s disease. J Am Geriatr Soc 56:946–947
Baker NL, Cook MN, Arrighi HM, Bullock R (2011) Hip fracture risk and subsequent mortality among Alzheimer’s disease patients in the United Kingdom, 1988–2007. Age Ageing 40(1):49–54
Berdot S, Bertrand M, Dartigues JF et al (2009) Inappropriate medication use and risk of falls: a prospective study in a large community-dwelling elderly cohort. BMC Geriatr 9:30
Birks J (2006) Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Database Syst Rev Jan 25;(1):CD005593
Chen Y, Zhu LL, Zhou Q (2014) Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients. Ther Clin Risk Manag 10:437–448
Chung KA, Lobb BM, Nutt JG, Horak FB (2010) Effects of a central cholinesterase inhibitor on reducing falls in Parkinson disease. Neurology 75(14):1263–1269
D’Andrea Greve JM, Luna NM, de Siqueira JP, Prota C, Alonso AC (2014) Assessment of postural balance among individuals with Parkinson disease with and without effects from dopaminergic medications. Am J Phys Med Rehabil 93(5):365–371
Dhall R, Krishnamurthi N, Lieberman A, Dhanani S, Pan D (2013) Why levodopa may increase falls in parkinson’s disease. Neurology 80(Meeting Abstract)
Dolgonos O, Tam S, Golshan S, Sargent J, Daly JW, Sewell D (2011) Impact of acetylcholinesterase inhibitors on fall risk in later stages of dementia. J Am Geriatr Soc 59:S45
Dubois B, Tolosa E, Katzenschlager R et al (2012) Donepezil in Parkinson’s disease dementia: a randomized, double-blind efficacy and safety study. Mov Disord 27:1230–1238
Elmer LW, Surmann E, Boroojerdi B, Jankovic J (2012) Long-term safety and tolerability of rotigotine transdermal system in patients with early-stage idiopathic Parkinson’s disease: a prospective, open-label extension study. Parkinsonism Relat Disord 18(5):488–493
Emre M, Aarsland D, Albanese A et al (2004) Rivastigmine for dementia associated with Parkinson’s disease. N Engl J Med 351:2509–2518
Epstein NU, Guo R, Farlow MR, Singh JP, Fisher M (2014) Medication for Alzheimer’s disease and associated fall hazard: a retrospective cohort study from the Alzheimer’s disease neuroimaging initiative. Drugs Aging 31(2):125–129
French DD, Campbell R, Spehar A, Cunningham F, Foulis P (2005) Outpatient medications and hip fractures in the US: a national veterans study. Drugs Aging 22(10):877–885
French DD, Campbell R, Spehar A, Cunningham F, Bulat T, Luther SL (2006) Drugs and falls in community-dwelling older people: a national veterans study. Clin Ther 28(4):619–630
Gammon K (2014) Neurodegenerative disease: brain windfall. Nature 515:299–300
Genever RW, Downes TW, Medcalf P (2005) Fracture rate in Parkinson’s disease compared with age and gender matched controls: a retrospective cohort study. Age Ageing 34:21–24
Gill SS, Anderson GM, Fischer HD, Bell CM, Li P, Normand SL, Rochon PA (2009) Syncope and its consequences in patients with dementia receiving cholinesterase inhibitors: a population-based cohort study. Arch Intern Med 169(9):867–873. doi:10.1001/archinternmed.2009.43
Gray P, Hildebrand K (2000) Fall risk factors in Parkinson’s disease. J Neurosci Nurs 32:222–228
Grubb E, Treglia M, Lage M, Castelli-Haley J (2013) Comparison of hospitalizations, emergency room visits, fractures, and falls among parkinson disease patients who initiated therapy with selegiline or rasagiline: a retrospective study. Value Health 16(3):A105
Hartikainen S, Lönnroos E, Louhivuori K (2007) Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci 62(10):1172–1181
Hiorth YH, Larsen JP, Lode K, Pedersen KF (2014) Natural history of falls in a population-based cohort of patients with Parkinson’s disease: an 8-year prospective study. Parkinsonism Relat Disord 20(10):1059–1064
Huang A, Redpath C, Van Walraven C (2015) The influence of cholinesterase therapy for dementia on risk of cardiac pacemaker insertion: a retrospective, population-based, health administrative databases study in Ontario, Canada. BMC Neurol 15:66
Kallin K, Gustafson Y, Sandman PO, Karlsson S (2004) Drugs and falls in older people in geriatric care settings. Aging Clin Exp Res 16(4):270–276
Kareus SA, Lai A, Horak FB, Nutt JG, Chung KA (2012) The effect of donepezil on a quantitative measure of balance in Parkinson’s disease. Mov Disord 27:S123
Kim DH, Brown RT, Ding EL, Diel DP, Berry SD (2011) Dementia Medications and Risk of Falls, Syncope and Related Advserse Events: Meta-Analysis of Randomized Controlled Trials. JAGS. 59(6):1019–31. doi:10.1111/j.1532-5415.2011.03450.x. Epub 2011 Jun 7
Kumar H, Mondal B, Sen S, Chatterjee P, Choudhury S, Anand SS et al (2014) Objective gait analysis in Parkinson’s disease reflecting the effect of levodopa. Ann Indian Acad Neurol 17:S175
Matinolli M, Korpelainen JT, Sotaniemi KA, Myllyla VV, Korpelainen R (2011) Recurrent falls and mortality in Parkinson’s disease: a prospective two-year follow-up study. Acta Neurol Scand 123(3):193–200
McShane R, Areosa Sastre A, Minakaran N (2006) Memantine for dementia. Cochrane Database Syst Rev (2):CD003154
Montero-Odasso M, Wells J, Borrie M (2009) Can cognitive enhancers reduce the risk of falls in people with dementia? An open-label study with controls. J Am Geriatr Soc 57(2):359–360
Montero-Odasso M, Borrie J, Wells M, Speechley M (2009) Can cognitive enhancers reduce the risk of falls in older people with mild cognitive impairment? A protocol for a randomised controlled double blind trial. BMC Neurol 9:42. doi:10.1186/1471-2377-9-42
Morris JC, Rubin EH, Morris E (1987) Senile dementia of the Alzheimer’s type: an important risk factor for serious falls. J Gerontol 42:412–417
Oertel W, LeWitt P, Giladi N, Ghys L, Grieger F, Boroojerdi B (2013) Treatment of patients with early and advanced Parkinson’s disease with rotigotine transdermal system: age-relationship to safety and tolerability. Parkinsonism Relat Disord 19(1):37–42
Olazaran J, Valle D, Serra JA, Cano P, Muniz R (2013) Psychotropic medications and falls in nursing homes: a cross-sectional study. J Am Med Dir Assoc 14(3):213–217
Pagano G, Rengo G, Pasqualetti G, Femminella GD, Monzani F, Ferrara N, Tagliati M (2014) Cholinesterase inhibitors for Parkinson’s disease: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. pii: jnnp-2014-308764; 767–73. doi:10.1136/jnnp-2014-308764. [Epub ahead of print]
Parashos S, Wielinski C, Nance M (2013) Lack of association between central anticholinesterase treatment and falls in Parkinson disease. J Park Dis 3:129
Rolinski M, Fox C, Maidment I, McShane R (2012) Cholinesterase inhibitors for dementia with Lewy bodies, Parkinson's disease dementia and cognitive impairment in Parkinson's disease. Cochrane Database Syst Rev (3):CD006504. doi:10.1002/14651858.CD006504.pub2
Shaw FE (2007) Prevention of falls in older people with dementia. J Neural Transm 114:1259–1264
Shuto H, Imakyure O, Matsumoto J, Egawa T, Jiang Y, Hirakawa M et al (2010) Medication use as a risk factor for inpatient falls in an acute care hospital: a case-crossover study. Br J Clin Pharmacol 69(5):535–542
Suttanon P, Hill KD, Said CM, Logiudice D, Lautenschlager NT, Dodd KJ (2012) Balance and mobility dysfunction and falls risk in older people with mild to moderate Alzheimer disease. Am J Phys Med Rehabil 91(1):12–23
Tamimi I, Ojea T, Sanchez-Siles JM, Rojas F, Martin I, Gormaz I, Perez A, Dawid-Milner MS, Mendez L, Tamimi F (2012) Acetylcholinesterase inhibitors and the risk of hip fracture in Alzheimer’s disease patients: a case-control study. J Bone Miner Res 27(7):1518–1527. doi:10.1002/jbmr.1616
Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707
Van DC, Gruber-Baldini AL, Zimmerman S et al (2003) Dementia as a risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc 51:1213–1218
Vestergaard P, Rejnmark L, Mosekilde L (2007) Fracture risk associated with parkinsonism and anti-parkinson drugs. Calcif Tissue Int 81:153–161
Wood BH, Bilclough JA, Bowron A, Walker RW (2002) Incidence and prediction of falls in Parkinson’s disease: a prospective multidisciplinary study. J Neurol Neurosurg Psychiatry 72:721–725
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Lemay, G. (2016). Drugs for Degenerative Neurologic Conditions: Antiparkinson Medications, Cholinesterase Inhibitors, and Memantine. In: Huang, A., Mallet, L. (eds) Medication-Related Falls in Older People. Adis, Cham. https://doi.org/10.1007/978-3-319-32304-6_11
Download citation
DOI: https://doi.org/10.1007/978-3-319-32304-6_11
Published:
Publisher Name: Adis, Cham
Print ISBN: 978-3-319-32302-2
Online ISBN: 978-3-319-32304-6
eBook Packages: MedicineMedicine (R0)