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Anticholinergic drugs linked to dementia

Clinicians should consider long-term effects of some anticholinergic medications 

Clinicians should consider long-term effects of some anticholinergic medications 


People with dementia were up to 30% more likely to have been prescribed specific anticholinergics. Picture: iStock

Anticholinergic drugs are used to treat a variety of conditions and work by blocking acetylcholine, a key neurotransmitter.

Long-term use of some anticholinergic medications, including antidepressants such as amitriptyline and paroxetine, is associated with an increased risk of dementia even when taken many years before a diagnosis.

This UK study was the largest and most detailed of its kind into the long-term effect of anticholinergic drug use in relation to dementia. The research team explored if there were links between different classes of anticholinergic medication and incidence of dementia diagnosis. The medical records of 40,770 patients aged over 65 diagnosed with dementia were compared with those of 283,933 people without dementia. More than 27 million prescriptions were analysed.

Researchers studied patients with a new dementia diagnosis and the anticholinergic medication they were prescribed between four and 20 years before being diagnosed. They found that people who had been diagnosed with dementia were up to 30% more likely to have been prescribed specific classes of anticholinergic medications.

Results and implications for practice

  • Results showed a greater incidence of dementia among patients prescribed greater quantities of anticholinergic antidepressant, urological and antiparkinson drugs.
  • Gastrointestinal and cardiovascular anticholinergic drugs were not found to be linked to dementia.
  • Clinicians should consider the possible long-term effects of certain classes of anticholinergic medication before prescribing.

Richardson K, Fox C, Maidment I et al (2018) Anticholinergic drugs and risk of dementia: case-control study. BMJ. 361:k1315. doi:10.1136/bmj.k1315.


Compiled by Ruth Sander, independent consultant in care of the older person

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