Anticholinergic drugs linked to incident dementia and cognitive decline

  • Pieper NT & al.
  • Age Ageing
  • 29 Jun 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Anticholinergic drug use, particularly long-term use, was associated with increased dementia incidence and cognitive decline.
  • However, no causal relationship was established, as studies were observational with considerable risk of bias.

Why this matters

  • Prescribers should carefully consider the potential benefits and harms when initiating and continuing anticholinergic drugs.

Study design

  • 26 studies including 621,548 participants met eligibility criteria after a search across electronic databases.
  • Funding: Alzheimer’s Society UK.

Key results

  • The pooled OR for any use of drugs with definite anticholinergic activity and incident dementia was 1.20 (95% CI, 1.09-1.32; I2, 86%).
  • Short-term (≥90 days; OR, 1.23; 95% CI, 1.17-1.29) and long-term (≥365 days; OR, 1.50; 95% CI, 1.22-1.85; I2, 90%) anticholinergic use were associated with incident dementia.
  • Greater cognitive decline was consistently seen in patients taking anticholinergic drugs (standardised mean difference, 0.15; 95% CI, 0.09-0.21) with no statistically significant difference for mild cognitive impairment (OR, 1.24; 95% CI, 0.97-1.59).

Limitations

  • Heterogeneity among included studies.
  • Risk of bias and residual confounding.