Common Anticholinergics Linked with Dementia Even When Taken 20 Years Before Diagnosis

27 April, 2018, 01:12 | Author: Angelica Greene
  • New research by the University of East Anglia suggests that anticholinergics may have triggered some 20,000 cases out of 850,000 in the UK

Long-term use of anticholinergic medications for Parkinson's disease, bladder conditions, and depression was associated with an increased risk for dementia, a case-control study found.

They analysed data from the UK's Clinical Practice Research Database for 40,770 patients aged 65 to 99 years who were diagnosed with dementia between April 2006 and July 2015.

"In total, there were 27 million prescription events that we were looking at over that period", Savva said.

The team drilled down to see whether there were links between different classes of anticholinergic medication and incidence of dementia diagnosis.

While study author Dr. Ian Maidment, a senior lecturer in clinical pharmacy at Aston University, urged medical providers to de-prescribe anticholinergic drugs, another of the study's authors recommended caution because more research is necessary to understand the link between the drugs and dementia. "Previously, antihistamines have been implicated (in dementia risk), but we've not found any association between those specifically and dementia, as well as the gastrointestinal drugs", Savva said. Dementia increased with greater exposure to anticholinergic medications.

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To examine these associations, researchers used multiple conditional logistic regression to evaluate patients with a new diagnosis of dementia and compared their anticholinergic drug use 4-20 years before diagnosis; they were then matched to a control group without dementia. The early symptoms of dementia include depression and urinary incontinence, so it is possible the drugs were sometimes being prescribed for people who already had the early stages.

Experts emphasise that patients should not stop taking the drugs, as their benefits may outweigh any risk.

A spokesperson for the Medicines and Healthcare Products Regulatory Authority said it would look to see if any action should be taken."Patient safety is our highest priority and we continuously monitor the safety of all medicines on the United Kingdom market".

The research, funded by Alzheimer's Society, does not prove that some anticholinergics cause dementia but the authors said doctors should consider the long-term effects when prescribing. He told the BBC that compared with the risk posed by leading an unhealthy lifestyle, the potential risk of an anticholinergic drug contributing to the onset of the disease was "quite small".

The researchers, led by the University of East Anglia, stop short of claiming that the drugs cause dementia.

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"Not everyone with the conditions highlighted in the study will be prescribed these particular drugs, and the researchers did not find a link between dementia risk and anticholinergic drugs used to treat allergies, stomach problems or muscle spasms".

Drugs were scored according to their anticholinergic activity using the Anticholinergic Cognitive Burden (ACB) scale. Levels of acetylcholine are known to be significantly lower in people with Alzheimer's disease, the most common cause of dementia in older adults, according to the Mayo Clinic.

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

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

"We studied patients with a new dementia diagnosis and looked at what anticholinergic medication they were prescribed between four and 20 years prior to being diagnosed. In the meantime, I strongly advise patients with any concerns to continue taking their medicines until they have consulted their doctor or pharmacist".

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