Auto-generated: September 18 2019 07:08 AM GMT

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Source: DGNews  |  Posted 12 weeks ago

Anticholinergic Drugs Could Increase the Risk of Dementia

There is nearly an increased risk of dementia among patients aged 55 and over who have used strong anticholinergic medication daily for 3 years or more, according to a study published in JAMA Internal Medicine.

Anticholinergic drugs are prescribed to treat a variety of conditions, including chronic obstructive pulmonary disease, bladder conditions, allergies, gastrointestinal disorders and symptoms of Parkinson’s disease. These medicines can have short-term side effects, including confusion and memory loss, but it is less certain whether long-term use increases the risk of dementia.

The study looked at the medical records of 58,769 patients with a diagnosis of dementia and 225,574 patients without a diagnosis of dementia, all aged 55 and over and registered with United Kingdom GPs contributing data to the QResearch database, between January 1, 2004 and January 31, 2016.

The study findings showed increased risks of dementia for anticholinergic drugs overall and specifically for the anticholinergic antidepressants, antipsychotic drugs, anti-Parkinson’s drugs, bladder drugs and epilepsy drugs after accounting for other risk factors for dementia.

No increased risks were found for the other types of anticholinergic drug studied such as antihistamines and gastrointestinal drugs.

Tom Dening, MD, Centre for Dementia, University of Nottingham, Nottingham, United Kingdom, said: “This study provides further evidence that doctors should be careful when prescribing certain drugs that have anticholinergic properties. However, it’s important that patients taking medications of this kind don’t just stop them abruptly as this may be much more harmful. If patients have concerns, then they should discuss them with their doctor to consider the pros and cons of the treatment they are receiving.”

The 58,769 patients with dementia had an average age of 82 and 63% were women. Each dementia case was matched to 5 control patients of the same age, sex, and general practice.

Anticholinergic drug exposure was assessed using prescription information over a complete period of 10 years from 1 to 11 years before diagnosis of dementia or the equivalent dates in control patients, and was compared between the 2 patient groups. Further analysis looked at prescriptions for anticholinergic drugs up to 20 years before diagnosis of dementia.

Carol Coupland, PhD, Division of Primary Care, University of Nottingham, said: “Our study adds further evidence of the potential risks associated with strong anticholinergic drugs, particularly antidepressants, bladder antimuscarinic drugs, anti-Parkinson drugs and epilepsy drugs.

“The risks of this type of medication should be carefully considered by healthcare professionals alongside the benefits when the drugs are prescribed and alternative treatments should be considered where possible, such as other types of antidepressants or alternative types of treatment for bladder conditions. These findings also highlight the importance of carrying out regular medication reviews.

“We found a greater risk for people diagnosed with dementia before the age of 80 which indicates that anticholinergic drugs should be prescribed with caution in middle-aged people as well as in older people.”

In the 1-11 years before the dementia diagnosis date or equivalent in controls, nearly 57% of cases and 51% of controls were prescribed at least 1 strong anticholinergic drug, with an average of 6 prescriptions in cases and 4 in controls. The most frequently-prescribed types of drugs were antidepressants, anti-vertigo and bladder antimuscarinic drugs.

The increased risk associated with these drugs indicates that if the association is causal around 10% of dementia diagnoses could be attributable to anticholinergic drug exposure, which would equate to around 20,000 of the 209,600 new cases of dementia per year in the United Kingdom.

This is a sizeable proportion and is comparable with other modifiable risk factors for dementia, including 5% for midlife hypertension, 3% for diabetes, 14% for later life smoking and 6.5% for physical inactivity.

Reference: doi:10.1001/jamainternmed.2019.0677

SOURCE: University of Nottingham

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