Anticholinergic Drug Use and Dementia: What's the Link?

Anticholinergic Drug Use and Dementia: What's the Link?

Anticholinergic Drug Use and Dementia: What's the Link?

Long-term use of some antidepressants is associated with an increased risk of dementia, even when taken up to 20 years before a diagnosis, according to a large British study.

Millions of older people are on cocktails of pills and Global Positioning System must take more seriously attempts to get them off these medications, the authors said.

The association was also seen with antidepressants (adjusted OR 1.11, 95% CI 1.08-1.14, P 0.01), they wrote in The BMJ.

The team drilled down to see whether there were links between different classes of anticholinergic medication and incidence of dementia diagnosis.

Antihistamines and other less potent anticholinergics used for travel sickness or stomach cramps were not linked to dementia, the report said.

Dementia was linked to increasing exposure to antidepressant, urological and antiparkinson drugs.

The study of more than 300,000 people in Britain found that those diagnosed with dementia were nearly a third more likely to have been prescribed so-called anticholinergic medicines to treat depression and certain bladder conditions between four and 20 years earlier. Conversely, the use of gastrointestinal drugs (ACB score 1 or 3) and cardiovascular drugs (ACB score 1) was linked to a minor reduction in dementia risk.

Though the 30% increased risk of developing dementia from long-term anticholinergic use is significant, it is still less than the risk associated with other modifiable risk factors for dementia such as smoking, social isolation and physical inactivity. The early symptoms of dementia include depression and urinary incontinence, so it is possible the drugs were sometimes being prescribed for people who already had the early stages.

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"We don't exactly know within those that are taking these drugs, who is at the increased risk and who isn't", he said. "And we found that about 9% of our (dementia) cases had taken anticholinergics in the past, compared to about 6% of our controls". "This could be caused by a class specific effect, or by drugs being used for very early symptoms of dementia".

The study, led by a team at the University of East Anglia in the United Kingdom, involved a collaboration between teams in the United Kingdom, US and Ireland."These findings make it clear that clinicians need to carefully consider the anticholinergic burden of their patients and weigh other options", claims Malaz Boustani, M.D., MPH, a Regenstrief Institute and Indiana University (IU) Center for Aging Research investigator, and co-author of the researchers' published paper in the BMJ.

The researchers say that while the associations appear "moderate", they still reflect an "appreciable risk to patients", given the high incidence of dementia.

"Many of the treatment options for these conditions involve medication with anticholinergic effects".

"In the last 20 years, the number of older individuals taking five or more medicines has quadrupled", said Dr Ian Maidment, senior lecturer in clinical pharmacy at Aston University.

As a group, these are known as anticholinergic drugs. The warning to not use anticholinergic drugs in Parkinson's disease is also important.

But the researchers warned that patients should not stop taking the drugs without talking to their doctor first. "In the meantime, I strongly advise patients with any concerns to continue taking their medicines until they have consulted their doctor or pharmacist".

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