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Medication for Alzheimer’s Disease and Associated Fall Hazard: A Retrospective Cohort Study from the Alzheimer’s Disease Neuroimaging Initiative

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Abstract

Background

Falls are common in the elderly, especially in those with cognitive impairment. The elderly are often treated with several medications, which may have both beneficial and deleterious effects. The use and type of medication in Alzheimer’s disease (AD) patients and association with falls is limited.

Objective

We examined the association between falls and medication use in the Alzheimer’s Disease Neuroimaging Initiative (ADNI).

Methods

Diagnosis, demographics, medication use, apolipoprotein E4 allele status and functional activity level at baseline were gathered for 810 participants enrolled in the ADNI, including healthy controls and subjects with mild cognitive impairment or Alzheimer’s. Reports detailing adverse event falls were tabulated. Baseline characteristics were compared between subjects with and without one or more falls. Cox proportional hazards models were conducted to evaluate the association between subject characteristics and hazard of the first fall.

Results

Age (p < 0.0001), Functional Activities Questionnaire (p = 0.035), Beers List (p = 0.0477) and medications for treating cognitive symptoms of Alzheimer’s (p = 0.0019) were associated with hazard of fall in the univariate model. In the final multivariate model, after adjusting for covariates, Alzheimer’s medication use (p = 0.0005) was associated with hazard of fall. Medication was changed by the clinician after an adverse fall event in 9 % of the falls. About 7 % of the falls were reported as serious adverse events and 6 % were reported to be severe.

Conclusion

We found a significant association between the use of symptomatic medication treating cognitive symptoms in AD and hazard of fall after adjusting for age and Beers List medication use. Additional pharmacovigilance of the association between falls and Alzheimer’s medication use is warranted.

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Acknowledgments

Data used in the preparation of this article were obtained from the ADNI database (adni.loni.ucla.edu). As such, the investigators within the ADNI contributed to the design and implementation of the ADNI and/or provided data but did not participate in the analysis or writing of this report. A complete listing of ADNI investigators can be found at http://adni.loni.ucla.edu/wp-content/uploads/how_to_apply/ADNI_Acknowledgement_List.pdf.

Dr. Epstein conceived the idea, developed the protocol, collected the data and wrote the manuscript. Dr. Guo, an academic biostatistician, performed the statistical analysis. Dr. Singh helped with planning of the analysis. Drs. Singh, Farlow and Fisher helped with manuscript composition. All authors edited and approved the final manuscript.

Dr. Farlow receives research funding from Bristol Myers Squibb Company, Danone Research, Elan Pharmaceuticals, Inc., Eli Lilly and Company, Genentech, Novartis Pharmaceuticals Corporation, Octa-Pharma AG, Pfizer Inc., Sanofi-aventis, and Sonexa Therapeutics, Inc.; receives honoraria as a scientific consultant for Accera, Inc., Astellas Pharma US Inc., Baxter Healthcare Corp., Bayer Pharmaceuticals Corporation, Bristol Myers Squibb, DDB Remedy, Eisai Medical Research, Inc., GE Healthcare, Helicon, Medavante, Medivation, Inc., Merck & Co., Inc., Novartis Pharmaceuticals Corp., Pfizer, Inc., Prana Biotechnology Ltd, QR Pharma., Inc., the Sanofi-aventis Group, and Toyama Chemical Co., Ltd; is speaker for Eisai Medical Research, Inc., Forest Laboratories, Pfizer Inc. and Novartis Pharmaceuticals Corporation; and is a partial owner of Chemigen, Inc., core leader for P30.

Data collection and sharing for this project was funded by the ADNI (National Institutes of Health Grant U01 AG024904). ADNI is funded by the National Institute on Aging, the National Institute of Biomedical Imaging and Bioengineering, and through generous contributions from the following: Abbott; Alzheimer’s Association; Alzheimer’s Drug Discovery Foundation; Amorfix Life Sciences Ltd; AstraZeneca; Bayer HealthCare; BioClinica, Inc.; Biogen Idec Inc.; Bristol-Myers Squibb Company; Eisai Inc.; Elan Pharmaceuticals Inc.; Eli Lilly and Company; F. Hoffmann-La Roche Ltd and its affiliated company Genentech, Inc.; GE Healthcare; Innogenetics, N.V.; Janssen Alzheimer Immunotherapy Research & Development, LLC; Johnson & Johnson Pharmaceutical Research & Development, LLC; Medpace, Inc.; Merck & Co., Inc.; Meso Scale Diagnostics, LLC; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Servier; Synarc Inc.; and Takeda Pharmaceutical Company. The Canadian Institutes of Health Research provides funds to support ADNI clinical sites in Canada. Private sector contributions are facilitated by the Foundation for the National Institutes of Health (http://www.fnih.org). The grantee organization was the Northern California Institute for Research and Education, and the study was coordinated by the Alzheimer’s Disease Cooperative Study at the University of California, San Diego. ADNI data are disseminated by the Laboratory of Neuro Imaging at the Rev. August 16, 2011 University of California, Los Angeles. This research was also supported by NIH grants P30, AG010129, K01 AG030514, and the Dana Foundation.

Drs. Epstein, Singh and Fisher, and Rong Guo have nothing to disclose.

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Authors and Affiliations

  1. Department of Neurology, Hines VA Medical Center, 5000 South 5th Avenue, Hines, IL, 60141, USA

    Noam U. Epstein & Morris Fisher

  2. Department of Neurology, Loyola University School of Medicine, Maywood, IL, USA

    Noam U. Epstein, Jaswinder P. Singh & Morris Fisher

  3. Office of Research Services, Health Sciences Division, Loyola University Chicago, Maywood, IL, USA

    Rong Guo

  4. Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA

    Martin R. Farlow

  5. Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA

    Martin R. Farlow

Authors
  1. Noam U. Epstein
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  2. Rong Guo
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  3. Martin R. Farlow
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  4. Jaswinder P. Singh
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  5. Morris Fisher
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Corresponding author

Correspondence to Noam U. Epstein.

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For the Alzheimer’s Disease Neuroimaging Initiative (ADNI).

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Epstein, N.U., Guo, R., Farlow, M.R. et al. Medication for Alzheimer’s Disease and Associated Fall Hazard: A Retrospective Cohort Study from the Alzheimer’s Disease Neuroimaging Initiative. Drugs Aging 31, 125–129 (2014). https://doi.org/10.1007/s40266-013-0143-3

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  • DOI: https://doi.org/10.1007/s40266-013-0143-3

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