The study by Gill et al1 suggested a higher risk of adverse outcomes including syncope, bradycardia, pacemaker insertions, and hip fractures in community-dwelling adults with dementia receiving cholinesterase inhibitors compared with well-matched controls. These findings have important implications, as the agents in question remain the mainstay of symptomatic treatment for an otherwise debilitating illness.
It is interesting to note that while the incidence of hospital visits for syncope are comparatively higher in the cholinesterase inhibitor cohort (2.2% vs 1.5% in controls, see Table 3 in Gill et al1), the incidences for all other adverse outcomes are actually almost identical between cholinesterase inhibitor and control groups (hospital visits for bradycardia, 0.5% vs 0.4%; pacemaker insertions, 0.3% vs 0.3%; and hospitalizations for hip fractures, 1.6% vs 1.6%). The significant difference noted in the event rates and subsequent hazard ratios are therefore mainly influenced by the shorter follow-up periods reported for the cholinesterase inhibitor group (hospitalization due to hip fractures, mean follow-up times were 252 days and 302 days for the cholinesterase inhibitor and control cohorts, respectively.) Unfortunately, there was no clarification for this disparity in the article text.