Anticholinergics tied to dementia risk in older adults

  • BMJ

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.”

Study design

  • 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.

Limitations

  • Potential misclassification of dementia status.
  • Patient drug adherence unknown.
  • Unmeasured/residual confounding.

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