As people get older, they’re more likely to need medications on a regular basis to manage one or more chronic conditions. Some of these medications fall into a class known as anticholinergics and may not be ideal to take for long periods because they could increase the risk of dementia.
Study Shows Higher Risk of Anticholinergic Drugs
Previous research has shown an association between the use of anticholinergic medications — antidepressants, antipsychotics, bladder medications and drugs to treat Parkinson’s disease and epilepsy — and increased dementia risk for older adults.
The latest study, from researchers at the University of Nottingham and published in the JAMA Internal Medicine June 2019 issue, showed an even higher risk associated with the long-term use of certain anticholinergic drugs among people 55 and older.
“We found that people with a total anticholinergic exposure of more than one thousand and ninety five daily doses within a ten-year period before diagnosis, not counting the year before diagnosis, had a forty nine percent increased risk, compared to people who did not take these anticholinergic medications,” says study author Carol Coupland, professor of medical statistics in primary care at the University of Nottingham’s School of Medicine. “This is equivalent to three years’ daily use of a single strong anticholinergic medication or one year’s daily use of three strong anticholinergic drugs.”
“It’s important that patients taking these medications don’t just stop them abruptly without consulting their doctor, as this could be harmful.”
Experts aren’t sure why the drugs are linked to increased dementia risk, but inflammation or vascular changes may be a factor. One study by Indiana University in 2017 found that anticholinergic drug use was linked to increased brain atrophy, possibly because of the way the drug metabolizes in the brain.
A Growing Body of Research
The new study from the University of Nottingham was observational, as was previous research, which means it doesn’t prove or disprove that anticholinergics cause dementia. For example, it’s possible that people who are at increased risk of dementia also are at increased risk of other conditions for which they took the medication. More research is needed to determine whether the drugs actually cause dementia.
But the association with the increased risk is concerning. Up to 27% of older adults take anticholinergics, which are prescribed to treat a variety of conditions, from depression to urinary incontinence to chronic obstructive pulmonary disorder (COPD).
The latest study adds to what experts know about anticholinergics’ risk of dementia. For years, the American Geriatrics Society Beers Criteria has included many anticholinergics on its list of medications that may not be safe for older adults. And patient advocacy groups like the Parkinson’s Foundation have educated people about the problem.
“We have, for many years, steered Parkinson’s disease patients away from anticholinergic medications because of worries about the short- and long-term consequences of their usage,” says Dr. Michael S. Okun, executive director of the Fixel Institute for Neurological Diseases at the University of Florida Health and medical director of the Parkinson’s Foundation. “This study adds to the expanding literature suggesting that avoiding most anticholinergics is a good idea.”
Discuss Alternatives With Your Doctor
If you’ve been taking an anticholinergic drug, or if you’ve just been prescribed one, discuss the pros and cons of the medication with your doctor, Okun says.
Find out if there’s another drug in a different class which may treat your condition.
“Some of our older antidepressants are more anticholinergic — so we’ve moved away from prescribing those because there are potentially better agents, in terms of effectiveness and safety,” says Nicole Brandt, professor of pharmacy practice and science and executive director of the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland School of Pharmacy, who has served on several panels to update the American Geriatrics Society’s Beers Criteria.
When no alternative is available, educate yourself as much as possible to make an appropriate decision.
“If there are no effective non-anticholinergic medications or other non-drug interventions, then I think whether the benefits of taking the medication outweigh the potential risks depends very much on the individual circumstances and the severity of the condition for which treatment is needed,” Coupland says.
Also, consider whether you’ll be using the medication for a short or long period. The latest research found that dementia risk rose by 49% for people who took anticholinergics for three years, but only rose by 6% for people who took the drugs for less than three months.
If you decide to stop taking anticholinergics, tell your doctor so you can do it safely.
“It’s important that patients taking these medications don’t just stop them abruptly without consulting their doctor, as this could be harmful,” Coupland says.
If you take several medications and aren’t sure if any are anticholinergics, find out if you’re eligible for a free comprehensive medication review for Medicare Part D beneficiaries.
“That’s sitting down one-on-one with a health care provider, such as a pharmacist or maybe the doctor or nurse practitioner, to look at: are there potentially concerning medications and what are some suggestions they can make to the doctor?” Brandt says. “Sometimes [recommendations] from a health care provider to another health care provider is accepted more, because the patients may feel a little intimidated to have those conversations.”
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