Anticholinergic Drugs May Raise Dementia Risk

Use of anticholinergic medications such as antidepressants is linked with an increased risk of dementia as many as 20 years before any diagnosis of cognitive impairment, according to a study published online in The BMJ.

“Anticholinergics, medications that block acetylcholine, a nervous system neurotransmitter, have previously been implicated as a potential cause of cognitive impairment,” said study coauthor Noll Campbell, PharmD, of the Regenstrief Institute and Indiana University Center for Aging Research in Indianapolis. “This study is large enough to evaluate the long-term effect and determine that harm may be experienced years before a diagnosis of dementia is made.”

Dr. Campbell and colleagues came to the conclusion after analyzing more than 27 million prescriptions recorded in the medical records of 40,770 older adults diagnosed with dementia and 283,933 older adults without dementia.

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Among patients prescribed anticholinergic antidepressants, anticholinergic bladder medications, or anticholinergic Parkinson’s disease medications, the incidence of dementia was greater than in  patients not prescribed the medications, researchers found. With more exposure to anticholinergic drugs, the incidence of dementia grew.

Although researchers are unsure how anticholinergics may lead to dementia, they cautioned that health care providers should prescribe them with caution.

“These findings make it clear that clinicians need to carefully consider the anticholinergic burden of their patients and weigh other options,” said study coauthor Malaz Boustani, MD, MPH, of the Regenstrief Institute and Indiana University Center for Aging Research. “Physicians should review all the anticholinergic medications—including over-the-counter drugs—that patients of all ages are taking and determine safe ways to take individuals off anticholinergic medications in the interest of preserving brain health.”

—Jolynn Tumolo

References

Richardson K, Fox C, Maidment I, et al. Anticholinergic drugs and risk of dementia: case-control study. The BMJ. 2018 April 25;[Epub ahead of print].

Common class of drugs linked to dementia even when taken 20 years before diagnosis [press release]. Indianapolis, Indiana: Indiana University; April 26, 2018.