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Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: a systematic review and meta-analysis
  1. Pinar Soysal1,
  2. Ahmet Turan Isik1,
  3. Brendon Stubbs2,3,4,
  4. Marco Solmi5,6,
  5. Marco Volpe7,
  6. Claudio Luchini8,9,
  7. Grazia D'Onofrio10,
  8. Alberto Pilotto11,
  9. Enzo Manzato12,
  10. Giuseppe Sergi12,
  11. Patricia Schofield4,
  12. Nicola Veronese12
  1. 1Faculty of Medicine, Department of Geriatric Medicine, Center for Aging Brain and Dementia, Dokuz Eylul University, Izmir, Turkey
  2. 2Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
  3. 3Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
  4. 4Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
  5. 5Department of Neurosciences, University of Padova, Padova, Italy
  6. 6Psychiatry Unit, Monselice, Italy
  7. 7Neurology Division, Padova, Italy
  8. 8APSS Trento, Surgical Pathology Unit, Santa Chiara Hospital, Trento, Italy
  9. 9Department of Pathology, University of Verona, Verona, Italy
  10. 10Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
  11. 11Department of Ortho Geriatrics, Rehabilitation and Stabilization, Frailty Area, E.O. Galliera Hospital, NR-HS, Genoa, Italy
  12. 12Department of Medicine, Geriatrics Section, University of Padova, Padova, Italy
  1. Correspondence to Dr Nicola Veronese, Department of Medicine—DIMED, Geriatrics Division, University of Padova, Via Giustiniani 2, Padova 35128, Italy; ilmannato{at}


We conducted a systematic review and meta-analysis investigating the influence of acetylcholinesterase inhibitors (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 randomised double-blind placebo controlled (randomised controlled trials (RCTs)) studies of AChEIs in patients with dementia reporting nutritional status outcome data. Out of 3551 initial hits, 25 studies (12 open-label trials, 9 RCTs and 4 longitudinal studies) including 10 792 patients with dementia were meta-analysed. 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% to 34%, p<0.0001; I2=95%). These findings were confirmed in open-label trials (6%; 95% CI 4% to 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 to 3.17, p<0.0001; I2=29%). AChEIs therapy contributes to weight loss in patients with dementia, with a 2-fold 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.


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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.