- Dementia risk was elevated for older adults who had been prescribed medications having definite anticholinergic activity.
Why this matters
- Identifying modifiable risk factors for dementia is a priority.
- Prescription of ≥1 anticholinergic drugs with an Anticholinergic Cognitive Burden (ACB) score of 3 (definite anticholinergic activity) during the median 7.1-year exposure period was common among both cases (35%) and control group (30%).
- Odds ratio for dementia rose with average ACB score for exposure period, from 1.00 (score 5.0).
- Older adults had elevated risk after exposure to antidepressants (aOR, 1.11; 95% CI, 1.08-1.14), urologic agents (OR, 1.18; 95% CI, 1.13-1.23), and antiparkinson drugs (OR, 1.29; 95% CI, 1.11-1.50), but not gastrointestinal agents (OR, 0.94; 95% CI, 0.89-0.99), with ACB score of 3.
- Findings similar when exposure period was 15-20 years before diagnosis.
- Editorialists note that “for most highly anticholinergic drugs, nonpharmacological and pharmacological alternatives are available and should be considered.”
- UK case-control study of 40,770 patients aged 65-99 years with dementia vs 283,933 nondementia controls.
- Drug exposure periods assessed: 4-10, 10-15, 15-20 years before index date.
- Funding: Alzheimer’s Society.
- Potential misclassification of dementia status.
- Patient drug adherence unknown.
- Unmeasured/residual confounding.