Study finds link between popular medications and dementia risk

A study found that those diagnosed with dementia were almost a third more likely to have been prescribed anticholinergic medicines

Anticholinergic drugs that are commonly prescribed as antidepressants or for treating incontinence are linked with an increased risk of dementia, even when taken 20 years before cognitive impairment is diagnosed, according to data from what researchers claim is the largest and most detailed study of this class of drug.

As a general rule, they say, someone with a 10% of developing dementia in the next 15 years would see that increase to 13% if they had been on anticholinergics for a year or more - or a "one in 33 chance of getting dementia you would otherwise not have got".

Dr Parastou Donyai, associate professor of social and cognitive pharmacy at the University of Reading, said: "This type of study imagines that patients actually take their drugs as they were prescribed for them".

For drugs previously associated with delirium, the highest odds were seen with anticholinergic drugs for Parkinson's (adjusted OR 1.29, 95% CI 1.11-1.50, P 0.01) and bladder conditions (adjusted OR 1.18, 95% CI 1.13-1.23, P 0.01), reported George Savva, PhD, of the University of East Anglia in Norwich, England, and colleagues.

Other antidepressants (mainly selective serotonin reuptake inhibitors) with an ACB score of 1 were linked to dementia, but only close to the time of prescription, which the researchers say is unlikely to represent a direct (causal) link. Some Parkinson's drugs are also linked to a raised dementia risk.

A "robust" link was found between certain anticholinergic drugs, used to treat a variety of conditions, and future incidence of the neurological disorder. Dementia increased with greater exposure to anticholinergic medications. It could be that these medications are being prescribed for very early symptoms indicating the onset of dementia.

The data was pulled from a United Kingdom general practice database and looked at patient exposure to different classes of anticholinergic drugs. "And we found that about 9% of our (dementia) cases had taken anticholinergics in the past, compared to about 6% of our controls".

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"While there are important advantages to research that uses the rich data held in medical records, we know that less than 70 per cent of people with dementia receive a formal diagnosis, and this study may not tell the whole story".

What Do Anticholinergic Drugs Do?

Frequently prescribed anticholinergic drugs include procyclidine (Kemadrin) for Parkinson's; tolterodine, oxybutynin, and solifenacin (Vesicare) for urological conditions such as overactive bladder or incontinence; and amitriptyline, dosulepin, and paroxetine for depression. However, after a new study written by researchers at the University of East Anglia, we now face a new question: what should we do?

"Many of the treatment options for these conditions involve medication with anticholinergic effects". Levels of acetylcholine are known to be significantly lower in people with Alzheimer's disease, the most common cause of dementia in older adults, according to the Mayo Clinic.

"But patients, don't suddenly stop medications".

"In the last 20 years, the number of older individuals taking five or more medicines has quadrupled", said Dr Ian Maidment, senior lecturer in clinical pharmacy at Aston University. "In the meantime, I strongly advise patients with any concerns to continue taking their medicines until they have consulted their doctor or pharmacist".

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