Using Anticholinergic Medications over Depression Promotes Higher Dementia Risks

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A study links the long-term use of some drugs with a higher risk of dementia.

But a new study suggests that some classes of anticholinergic drugs - particularly those used to treat depression, Parkinson's and urinary incontinence - carry a higher risk than others.

The team urged people taking anticholinergic medicines not to stop without consulting their doctor or pharmacist.

Researchers from the United States, Britain and Ireland found anticholinergic drugs, which are often prescribed as antidepressants and for incontinence, may increase risk for dementia, based on analysis of 27 million prescriptions given to 40,770 people over age 65 who were diagnosed with dementia between April 2006 and July 2015.

Other antidepressants (mainly selective serotonin reuptake inhibitors) with an ACB score of 1 were linked to dementia, but only close to the time of prescription, which the researchers say is unlikely to represent a direct (causal) link. This means that some, but not all, anticholinergic drugs were implicated.

The researchers do stress that patients prescribed anticholinergic drugs shouldn't just stop taking their medicines.

The data was pulled from a United Kingdom general practice database and looked at patient exposure to different classes of anticholinergic drugs.

"Many medicines have this activity, and I think the key things from our finding is that it probably shifts the balance looking at risks versus benefits", said Ian Maidment, senior lecturer in clinical pharmacy at Aston University and another author on the study.

In the meantime, they agree that anticholinergics in general should be avoided in older adults.

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A total of 14,453 (35%) cases and 86,403 (30%) controls were prescribed at least 1 anticholingeric drug with an Anticholinergic Cognitive Burden (ACB) score of 3; 1429 (3.5%) cases and 7909 (2.8%) controls were prescribed drugs with an ACB score of 2; most patients (89% of cases and 87% of controls) received a drug with an ACB score of 1 during the drug exposure period (DEP).

Hundreds of thousands of people are taking routine medicines that increase their risk of dementia by up to a third, researchers have warned.

Dr Parastou Donyai, associate professor of social and cognitive pharmacy at the University of Reading, said: "This type of study imagines that patients actually take their drugs as they were prescribed for them". The data was compared to the data of 283,933 people that didn't have dementia.

They found that people who were on the drugs between four and 20 years earlier were more likely to have been diagnosed with dementia.

The new study is among the largest of its kind and adds to the existing literature linking long-term anticholinergic use with dementia, according to Dr. Clive Ballard, executive dean of University of Exeter Medical School, who was not involved in the research. "Not taking prescribed drugs could have serious consequences".

"There are robust associations between levels of anticholinergic antidepressants, antiparkinsons, and urologicals and the risk of a diagnosis of dementia up to 20 years after exposure", they wrote.

The adjusted OR for any anticholinergic drug with an ACB score of 3 being associated with dementia was 1.11 (95% CI 1.08-1.14, P 0.01), but drugs for gastrointestinal and respiratory conditions were not linked with dementia risk.

What should patients do if they take any of these drugs?

"Doctors and patients should therefore be vigilant about using anticholinergic medications".

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