nach oben

Erschienen in:

01.08.2005 | Original Research Article

Causes of Syncope in Patients with Alzheimer’s Disease Treated with Donepezil

verfasst von: Dr Philippe Bordier, Stephane Lanusse, Stephane Garrigue, Charlotte Reynard, Frederic Robert, Laurent Gencel, Alexia Lafitte

Erschienen in: Drugs & Aging | Ausgabe 8/2005

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Treatment of Alzheimer’s disease (AD) with cholinesterase inhibitors carries a theoretical risk of precipitating bradycardia. Though syncope occurs in patients with AD, its aetiology is unclear. The aim of this study was to determine the causes of syncope in patients with AD who were treated with donepezil and hospitalised for evaluation of syncope.

Methods

We studied 16 consecutive patients (12 women, 4 men) with AD aged 80 ± 4 years who were hospitalised for evaluation of syncope. All patients underwent staged evaluation, ranging from physical examination to electrophysiological testing.

Results

The mean dose of donepezil administered was 7.8 mg/day, and the mean duration of donepezil treatment at the time of syncope was 12 ± 8 months. A cause of syncope was identified in 69% of patients. Carotid sinus syndrome was observed in three patients, complete atrioventricular block in two patients, sinus node dysfunction in two patients, severe orthostatic hypotension in two patients and paroxysmal atrial fibrillation in one patient. A brain tumour was discovered in one patient. No cause of syncope was found in 31% of patients despite comprehensive investigation. Repetition of the investigations after discontinuation of donepezil was noncontributory.

Conclusion

In patients with AD treated with donepezil, a noninvasive evaluation identified a probable cause of syncope in over two-thirds of patients. Cardiovascular abnormalities were predominant. Noninvasive evaluation is recommended before discontinuing treatment with cholinesterase inhibitors in patients with AD and unexplained syncope.

The use of trade names is for product identification purposes only and does not imply endorsement.

Fox PJ, Kohatsu N, Max W, et al. Estimating the costs of caring for people with Alzheimer disease in California: 2000–2040. J Public Health Policy 2001; 22: 88–97PubMedCrossRef

Fratiglioni L, Launer LJ, Andersen K, et al. Incidence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 2000; 54: S10–5PubMed

Lobo A, Launer LJ, Fratiglioni L, et al. Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 2000; 54: S4–9PubMedCrossRef

Wolfson C, Wolfson DB, Asgharian M, et al. A reevaluation of the duration of survival after the onset of dementia. N Engl J Med 2001; 344: 1111–6PubMedCrossRef

Grutzendler J, Morris JC. Cholinesterase inhibitors for Alzheimer’s disease. Drugs 2001; 61: 41–52PubMedCrossRef

Shintani EY, Uchida KM. Donepezil: an anticholinesterase inhibitorfor Alzheimer’s disease. Am J Health Syst Pharm 1997; 54: 2805–10PubMed

Calvo-Romero JM, Ramos-Salado JL. Symptomatic sinus bradycardia associated with donepezil [in Spanish]. Rev Neurol 1999; 28: 1070–2PubMed

Shepherd G, Klein-Schwartz W, Edwards R. Donepezil overdose: a tenfold dosing error. Ann Pharmacother 1999; 33: 812–5PubMedCrossRef

Morganroth J, Graham S, Hartman R, et al. Electrocardiographic effects of rivastigmine. J Clin Pharmacol 2002; 42: 558–68PubMedCrossRef

10.

Mant T, Troetel WM, Imbimbo BP. Maximum tolerated dose and pharmacodynamics of eptastigmine in elderly healthy volunteers. J Clin Pharmacol 1998; 38: 610–7PubMed

11.

Greenberg SM, Tennis MK, Brown LB, et al. Donepezil therapy in clinical practice: a randomized crossover study. Arch Neurol 2000; 57: 94–9PubMedCrossRef

12.

Bordier P, Garrigue S, Barold SS, et al. Significance of syncope in patients with Alzheimer’s disease treated with cholinesterase inhibitors. Europace 2003; 5: 429–31PubMedCrossRef

13.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th rev. ed. Washington, DC: American Psychiatric Association, 1994

14.

McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s disease. Neurology 1984; 34: 939–44PubMedCrossRef

15.

Kapoor WN. Current evaluation and management of syncope. Circulation 2002; 106: 1606–9PubMedCrossRef

16.

The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. Neurology 1996; 46: 1470CrossRef

17.

Atkins D, Hanusa B, Sefcik T, et al. Syncope and orthostatic hypotension. Am J Med 1991; 91: 179–85PubMedCrossRef

18.

Bass EB, Curtiss El, Arena VC, et al. The duration of Holter monitoring in patients with syncope. Is 24 hours enough? Arch Intern Med 1990; 150: 1073–8PubMedCrossRef

19.

Brignole M, Alboni P, Benditt DG, et al. Guidelines on management (diagnosis and treatment) of syncope: update 2004. Eur Heart J 2004; 6: 467–537CrossRef

20.

Almquist A, Gornick CC, Benson Jr DW, et al. Carotid sinus hypersensitivity: evaluation of the vasodepressor component. Circulation 1985; 71: 927–36PubMedCrossRef

21.

Kenny RA, Richardson DA, Steen N, et al. Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). J Am Coll Cardiol 2001; 38: 1491–6PubMedCrossRef

22.

Pavri BB, Ho RT. Syncope: identifying cardiac causes in older patients. Geriatrics 2003; 58: 26–31PubMed

23.

Rees SA, Curtis MJ. Tacrine inhibits ventricular fibrillation induced by ischaemia and reperfusion and widens QT interval in rat. Cardiovasc Res 1993; 27: 453–8PubMedCrossRef

24.

Savci V, Gurun MS, Cavun S, et al. Cardiovascular effects of centrally injected tetrahydroaminoacridine in conscious nor-motensive rats. Eur J Pharmacol 1998; 346: 35–41PubMedCrossRef

25.

Fitzpatrick AP, Lee RJ, Epstein LM, et al. Effect of patient characteristics on the yield of prolonged baseline head-up tilt testing and the additional yield of drug provocation. Heart 1996; 76: 406–11PubMedCrossRef

26.

McLaren AT, Allen J, Murray A, et al. Cardiovascular effects of donepezil in patients with dementia. Dement Geriatr Cogn Disord 2003; 15: 183–8PubMedCrossRef

27.

Click RL, Gersh BJ, Sugrue DD, et al. Role of invasive electrophysiologic testing in patients with symptomatic bundle branch block. Am J Cardiol 1987; 59: 817–23PubMedCrossRef

28.

Graham LA, Gray JC, Kenny RA. Comparison of provocative tests for unexplained syncope: isoprenaline and glyceryl trinitrate for diagnosing vasovagal syncope. Eur Heart J 2001; 22: 497–503PubMedCrossRef

29.

Del Rosso A, Ungar A, Bartoli P, et al. Usefulness and safety of shortened head-up tilt testing potentiated with sublingual glyceryl trinitrate in older patients with recurrent unexplained syncope. J Am Geriatr Soc 2002; 50: 1324–8PubMedCrossRef

30.

Kumar NP, Youde JH, Ruse C, et al. Responses to the prolonged head-up tilt followed by sublingual nitrate provocation in asymptomatic older adults. Age Ageing 2000; 29: 419–24PubMedCrossRef

31.

Kapoor W, Snustad D, Peterson J, et al. Syncope in the elderly. Am J Med 1986; 80: 419–28PubMedCrossRef

32.

Lipsitz LA, Wei JY, Rowe JW. Syncope in an elderly, institutionalised population: prevalence, incidence, and associated risk. Q J Med 1985; 55: 45–54PubMed

33.

Kenny RA. Syncope in the elderly: diagnosis, evaluation, and treatment. J Cardiovasc Electrophysiol 2003; 14: S74–7PubMedCrossRef

34.

Soteriades ES, Evans JC, Larson MG, et al. Incidence and prognosis of syncope. N Engl J Med 2002; 347: 878–85PubMedCrossRef

35.

O’Shea D. Setting up a falls and syncope service for the elderly. Clin Geriatr Med 2002; 18: 269–78PubMedCrossRef

36.

Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med 2002; 18: 141–58PubMedCrossRef

37.

Kapoor WN, Karpf M, Wieand S, et al. A prospective evaluation and follow-up of patients with syncope. N Engl J Med 1983; 309: 197–204PubMedCrossRef

38.

Hu T, Huang L, Cartwright WS. Evaluation of the costs of caring for the senile demented elderly: a pilot study. Gerontologist 1986; 26: 158–63PubMedCrossRef

39.

Rice DP, Fox PJ, Max W, et al. The economic burden of Alzheimer’s disease care. Health Aff 1993; 12: 164–76CrossRef

40.

Johnson N, Davis T, Bosanquet N. The epidemic of Alzheimer disease: how can we manage the costs? Pharmacoeconomics 2000; 18: 215–23PubMedCrossRef

41.

Brookmeyer R, Gray S, Kawas C. Projections of Alzheimer’s disease in the United States and the public health impact of delaying disease onset. Am J Public Health 1998; 88: 1337–42PubMedCrossRef

Titel: Causes of Syncope in Patients with Alzheimer’s Disease Treated with Donepezil
verfasst von: Dr Philippe Bordier
Stephane Lanusse
Stephane Garrigue
Charlotte Reynard
Frederic Robert
Laurent Gencel
Alexia Lafitte
Publikationsdatum: 01.08.2005
Verlag: Springer International Publishing
Erschienen in: Drugs & Aging / Ausgabe 8/2005
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI: https://doi.org/10.2165/00002512-200522080-00005

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren.

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Die „Zehn Gebote“ des Endokarditis-Managements

30.04.2024 Endokarditis Leitlinie kompakt

Worauf kommt es beim Management von Personen mit infektiöser Endokarditis an? Eine Kardiologin und ein Kardiologe fassen die zehn wichtigsten Punkte der neuen ESC-Leitlinie zusammen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Introduction

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2005

Effect of Age-Related Changes in Gastric Physiology on Tolerability of Medications for Older People

Catheter-Related Urinary Tract Infection

Drug Persistency of Two Cholinesterase Inhibitors

Underutilisation of Opioids in Elderly Patients with Chronic Pain

Revised Guidelines for the Diagnosis and Control of Tuberculosis