An estimated 47 million people worldwide were living with dementia in 2015, while in the United States, around 5.7 million people have Alzheimer’s dementia. Modifiable risk factors, including hypertension, hearing loss, depression, diabetes, and smoking, account for around 35% of dementia cases. Anticholinergic drugs are another potentially modifiable risk factor. This broad group of drugs acts by blocking the neurotransmitter acetylcholine in the central and peripheral nervous system and includes some antihistamines, antidepressants, and medications for gastrointestinal and bladder disorders. These medications can have short-term adverse effects, including confusion and memory loss in older people, but it is less certain whether long-term use increases the risk of dementia.

Anticholinergic Drug Exposure and the Risk of DementiaA Nested Case-Control Study

In a large, nested case-control study published in JAMA, they found an increased risk of dementia associated with anticholinergic medication use. Associations were strongest for the anticholinergic antidepressants, bladder antimuscarinics, antipsychotics, and antiepileptic drugs.

“Adverse effects should be considered alongside benefits when these drugs are prescribed, and alternative treatments should be considered where possible, such as other types of antidepressant or non-pharmacological treatments for depression, alternative antiparkinsonian drugs, and bladder training or mirabegron for overactive bladders”. Take a look at your monthly pharmacy report, how many of your residents are on anticholinergic medications? These medications are also on the BEERS list of medications to avoid in the elderly. Might be time to have a sit down with the attending physicians and pharmacy to discuss options and possibly avoid causing more harm! Stay informed, stay well and stay tuned!