First, do no harm? Common anticholinergic meds seen to increase dementia risk in older patients

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Com­mon­ly Pre­scribed Meds Could Raise Demen­tia Risk (Web­MD):

“Doc­tors often pre­scribe anti­cholin­er­gic drugs for a vari­ety of ills. But a new study sug­gests they may increase the risk of demen­tia in old­er patients.

These med­i­cines include every­thing from Benadryl (diphen­hy­dramine) to cer­tain antipsy­chotics and Parkin­son’s meds. They’re used to treat a wide range of oth­er con­di­tions, includ­ing depres­sion, chron­ic obstruc­tive pul­monary dis­ease, over­ac­tive blad­der, aller­gies, and gas­troin­testi­nal disorders.

Anti­cholin­er­gic drugs help con­tract and relax mus­cles, and work by block­ing acetyl­choline, a chem­i­cal that trans­mits mes­sages in the ner­vous sys­tem … the new British study found that peo­ple aged 55 and old­er who took strong anti­cholin­er­gic med­ica­tions dai­ly for three years or more had a 50% increased risk of demen­tia … Over­all, they study found an increased risk of demen­tia among those who took anti­cholin­er­gic drugs. After account­ing for oth­er risk fac­tors for demen­tia, the researchers con­clud­ed that strong anti­cholin­er­gic meds were asso­ci­at­ed with an increased risk of dementia.”

The Study:

Anti­cholin­er­gic Drug Expo­sure and the Risk of Demen­tia (JAMA Inter­nal Med­i­cine). From the Abstract:

  • Impor­tance: Anti­cholin­er­gic med­i­cines have short-term cog­ni­tive adverse effects, but it is uncer­tain whether long-term use of these drugs is asso­ci­at­ed with an increased risk of dementia.
  • Objec­tive: To assess asso­ci­a­tions between anti­cholin­er­gic drug treat­ments and risk of demen­tia in per­sons 55 years or older.
  • Expo­sures: The pri­ma­ry expo­sure was the total stan­dard­ized dai­ly dos­es (TSDDs) of anti­cholin­er­gic drugs pre­scribed in the 1 to 11 years pri­or to the date of diag­no­sis of demen­tia or equiv­a­lent date in matched con­trols (index date).
  • Main Out­comes and Mea­sures: Odds ratios (ORs) for demen­tia asso­ci­at­ed with cumu­la­tive expo­sure to anti­cholin­er­gic drugs, adjust­ed for con­found­ing variables.
  • Con­clu­sions and Rel­e­vance: Expo­sure to sev­er­al types of strong anti­cholin­er­gic drugs is asso­ci­at­ed with an increased risk of demen­tia. These find­ings high­light the impor­tance of reduc­ing expo­sure to anti­cholin­er­gic drugs in mid­dle-aged and old­er people.

The Study in Context: