Common Anticholinergics Heighten Dementia Risk

Anticholinergic drugs may be associated with dementia risk in older adults, according to new findings.

Researchers arrived at this conclusion following a study of 40,770 patients aged 65 to 99 years who received a diagnosis of dementia between April 2006 and July 2015, along with 283,933 controls without dementia.
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The Anticholinergic Cognitive Burden (ACB) scale was used to code daily defined doses of anticholinergic drugs. All anticholinergics prescribed 4 to 20 years before dementia onset were taken into account.

Overall, 14,453 (35%) cases and 86,403 (30%) controls were prescribed at least 1 anticholinergic drug. The ACB score during the exposure period was 3, and the adjusted odds ratio for any anticholinergic drug with an ACB score of 3 was 1.11.

Ultimately, the researchers found an association between dementia and increasing average ACB score. Dementia risk was found to increase with greater exposure to antidepressant, urological, and antiparkinson drugs (ACB score 3), and this result was evident for exposure occurring 15 to 20 years before dementia diagnosis.

However, when assessed by drug class, gastrointestinal drugs with an ACB score of 3 were not found to be distinctively associated with dementia risk.

“A robust association between some classes of anticholinergic drugs and future dementia incidence was observed,” the researchers wrote. “This could be caused by a class specific effect, or by drugs being used for very early symptoms of dementia.”

“Future research should examine anticholinergic drug classes as opposed to anticholinergic effects intrinsically or summing scales for anticholinergic exposure,” they concluded.

—Christina Vogt

Reference:

Richardson K, Fox C, Maidment I, et al. Anticholinergic drugs and risk of dementia: case-control study [Published online April 25, 2018]. BMJ. https://doi.org/10.1136/bmj.k1315

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