Drugs for degenerative neurologic conditions: Antiparkinson medications, cholinesterase inhibitors, and memantine

Abstract

Drugs for degenerative neurologic conditions like antiparkinson medications, cholinesterase inhibitors, and memantine are used for symptomatic treatment of Parkinson’s disease and for stabilization of decline or to slow progression of dementias, respectively. Since these drugs are not curative, knowing their risks is essential. In a population at higher risk of falls, does the use of these medications further increase that risk? A literature review showed a number of studies that included cholinesterase inhibitors demonstrated mixed results on their association with falls. Studies were often retrospective in nature and failed to account for confounders, limiting their interpretation. There was paucity of studies on memantine, but the available literature failed to show an association with falls. The small number of studies on antiparkinson medication showed an association between higher levodopa dose, but it remains unclear if this could be accounted for by the underlying disease duration and severity. At present, it remains essential to address the numerous fall-related risk factors in these high-risk populations. Although some literature has suggested an association between falls and these medications, it is arguably an association influenced or directly caused by the disease itself. Further studies of higher quality are needed to clarify this issue.