Some anticholinergics are linked to 50% greater dementia risk

  • Coupland CAC & al.
  • JAMA Intern Med
  • 24.06.2019

  • von Craig Hicks
  • Clinical Essentials
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Takeaway

  • Long-term exposure to some anticholinergics, especially antidepressants, antiparkinson drugs, antipsychotics, bladder antimuscarinics, and antiepileptic drugs, is associated with a significant increase in dementia risk.

Why this matters

  • Providers should prescribe these drugs with caution in middle-aged and older adults.

Study design

  • Study of 284,343 patients (58,769 with dementia and 225,574 matched control patients; age ≥55 years).
  • Funding: National Institute for Health Research School for Primary Care Research.

Key results

  • 56.6% of patients with dementia and 51.0% of control individuals were prescribed ≥1 anticholinergic drug.
  • For patients receiving anticholinergic drugs vs nonuse, dementia risk for total standardized daily doses (TSDDs) was:
    • 6% for 1-90 TSDDs:
      • aOR, 1.06 (95% CI, 1.03-1.09); and 
    • 49% for >1095 TSDDs:
      • aOR, 1.49 (95% CI, 1.44-1.54).
  • Risk for dementia was significant in patients receiving the following anticholinergics (aORs [95% CIs]):
    • Antidepressants: 1.29 (1.24-1.34).
    • Antiparkinson drugs: 1.52 (1.16-2.00).
    • Antipsychotics: 1.70 (1.53-1.90).
    • Bladder antimuscarinic drugs: 1.65 (1.56-1.75).
    • Antiepileptic drugs: 1.39 (1.22-1.57).
  • Stronger associations were observed in patients diagnosed before 80 years of age:
    • For >1095 TSDDs: aOR, 1.81 (95% CI, 1.71-1.91).

Limitations

  • Misclassification bias.

 Coauthored with Antara Ghosh, PhD