Anticholinergics’ link to dementia calls for vigilance in elderly

Antidepressant, urologic, and antiparkinson drugs with definite anticholinergic activity were associated with an increased risk of dementia as long as 20 years after exposure in a large observational study published in The BMJ.

Kathryn Richardson, PhD, of the University of East Anglia, Norwich, England, and her colleagues said that while the associations were “moderate” given the high incidence of dementia observed in the study, they nevertheless reflected an “appreciable risk” for patients.

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According to a linked editorial by Shelly L. Gray, PharmD, of the University of Washington, Seattle, and Joseph T. Hanlon, PharmD, of the University of Pittsburgh, the findings suggest that anticholinergics in general should be avoided in older adults (BMJ. 2018;361:k1722. doi: 10.1136/bmj.k1722).

“Specifically, for most highly anticholinergic drugs, nonpharmacological and pharmacological alternatives are available and should be considered,” they said.

The nested case-control study involved 40,770 patients from the United Kingdom’s Clinical Practice Research Database who were aged 65-99 years and diagnosed with dementia between April 2006 and July 2015. The research team matched the patients to 283,933 similar controls without dementia.

They scored drugs according to their anticholinergic activity using the Anticholinergic Cognitive Burden (ACB) scale: A score of 1 was classified as possibly anticholinergic, while a score of 2 or 3 was classified as having “definite” anticholinergic activity. Daily doses of each drug were then compared for both cases and controls over an exposure period of 4-20 years before a diagnosis of dementia.