Anticholinergic medications and risk of dementia in older adults: Where are we now?

ABSTRACT

Introduction

Anticholinergic medications are effective for a wide variety of indications, but are associated with significant central adverse effects, especially cognitive decline and dementia in older adults.

Areas covered

We conducted a review of relevant literature in the past decade to address anticholinergic scales and evidence of anticholinergic-related dementia/cognitive decline in older adults. We discussed various anticholinergic scales used to classify anticholinergic medications. The review focused on the evidence from previous reviews and individual studies evaluating the anticholinergic-related risk of developing cognitive decline/dementia. This review also discussed clinical and methodological issues of studies along with recommendations for practice and research.

Expert opinion

The review demonstrates moderate to strong risk of dementia with anticholinergic use in multiple studies involving older adults, irrespective of the study design, analytical approach, anticholinergic exposure and outcome definition. This risk is particularly significant with the cumulative burden and high-level anticholinergics. There also exists a dose–response relationship between anticholinergic use and increased risk for dementia. Therefore, anticholinergic agents can be considered as a modifiable risk factor for dementia and cognitive decline in older adults. Based on the current evidence, regular assessment and optimization of anticholinergic burden prior to prescribing these medications can minimize anticholinergic-related morbidity in older adults.

KEYWORDS:

• Anticholinergic
• dementia
• older adults

Article highlights

• Anticholinergic medications are commonly used in older adults for a wide variety of indications.

• Multiple anticholinergic scales are available to classify anticholinergic medications.

• Literature supports evidence of moderate to strong risk of dementia with anticholinergic use in older adults.

• There also exists a dose–response relationship between anticholinergic use and increased risk of dementia.

• Regular assessment of cognitive status and anticholinergic burden is needed in older adults to minimize anticholinergic-related morbidity.

This box summarizes key points contained in the article.

Declaration of interest

Dr Aparasu reports grants from Novartis, Incyte, and Astellas, outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.