Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: a systematic review and meta-analysis

We conducted a systematic review and meta-analysis investigating the influence of AChEIs therapy on nutritional status and weight across observational and interventional studies. Two authors searched major electronic databases from inception until 10/14/2015 for longitudinal, open-label and randomized double blind placebo controlled (RCTs) studies of AChEIs in patients with dementia reporting nutritional status outcome data. Out of 3,551 initial hits, 25 studies (12 open-label trials, 9 RCTs and 4 longitudinal studies) including 10,792 patients with dementia were meta analyzed. In longitudinal studies (median follow-up: 6 months), a significant cumulative incidence of weight loss between baseline and follow-up evaluation was observed (studies=2; 5%; 95%CI: 1-34%, p<0.0001; I2=95%). These findings were confirmed in open-label trials (6%; 95%CI: 4-7%, p<0.0001; I2=78%). In 9 RCTs (median follow-up: 5 months), those taking AChEIs more frequently experienced weight loss than participants taking placebo (OR=2.18; 95%CI: 1.50-3.17, p<0.0001; I2=29%). AChEIs therapy contributes to weight loss in patients with dementia, with a twofold increased risk observed in the meta-analysis of RCTs. Clinicians should carefully consider the benefit and risk of prescribing AChEIs. Nutritional status should be routinely evaluated in patients with dementia treated with AChEIs.