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Adverse effects of cholinesterase inhibitors used in Alzheimer's disease include cardiac disorders (bradycardia, conduction disorders) that can cause malaise and syncope. A cohort study compared 20 000 patients who received a cholinesterase inhibitor for dementia with a control group of untreated dementia patients. Cholinesterase inhibitor therapy was associated with statistically significant increases in hospitalisations for syncope or bradycardia, pacemaker insertion, and hip fracture. In practice, cholinesterase inhibitors have little more than a placebo effect and do not justify exposing patients to these risks.

Citation

Syncope with cholinesterase inhibitors. Prescrire international. 2011 Oct;20(120):240

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PMID: 21970087

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