Anticholinergics and Dementia: It’s the Drugs

Hello. I’m Dr Charles Vega, and I am a clinical professor of family medicine at the University of California at Irvine. Welcome to Medscape Morning Report, our 1-minute news story for primary care.

It is well known that anticholinergic medications affect cognition, with long-term exposure linked to dementia. Guidelines indicate that they are to be avoided in frail, elderly patients. However, it has been unclear whether the increased risk is specific to the anticholinergic or to the underlying conditions being treated.

A case-control study involving over 300,000 patients suggests that it is the drugs. Antidepressants, drugs for Parkinson’s, and urologic meds increase the risk of developing dementia for up to 20 years after exposure.

The data are observational and the associations were moderate, with an odds ratio ranging from 1.1 to 1.6 for exposure to drugs with a known risk for short-term cognitive dysfunction. However, given the high incidence of dementia, the investigators contend that this represents an appreciable risk to patients.

This study reinforces the need for a thorough drug history in our older patients because drugs with anticholinergic properties are out there in many forms.

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