A recent study conducted by researchers at the University of Nottingham has raised concerns about the long-term use of anticholinergic drugs and their potential link to an increased risk of dementia. The research, funded by the National Institute for Health Research (NIHR), suggests that prolonged use of certain commonly prescribed medications, particularly those used to treat bladder conditions, Parkinson’s disease, and depression, may significantly elevate the risk of developing dementia later in life.
The study, published in JAMA Internal Medicine, analyzed the medical records of 58,769 patients diagnosed with dementia and 225,574 control patients without dementia, all aged 55 and over. The data was sourced from the QResearch database, encompassing records from UK general practitioners between January 1, 2004, and January 31, 2016. The findings indicated that patients who had used strong anticholinergic medication daily for three years or more faced an almost 50% increased risk of dementia.
Specific Drug Categories of Concern
The study identified specific categories of anticholinergic drugs that posed a higher risk. These included anticholinergic antidepressants, antipsychotic drugs, anti-Parkinson drugs, bladder drugs, and epilepsy drugs. No increased risks were observed for other types of anticholinergic drugs, such as antihistamines and gastrointestinal drugs.
Professor Carol Coupland from the University’s Division of Primary Care, who led the research, emphasized the importance of carefully considering the risks associated with strong anticholinergic drugs. "Our study adds further evidence of the potential risks associated with strong anticholinergic drugs, particularly antidepressants, bladder antimuscarinic drugs, anti-Parkinson drugs and epilepsy drugs," she stated.
Expert Commentary
Dr. James Pickett, Head of Research at Alzheimer’s Society, commented on the study's implications, stating, “Our own researchers have already shown a strong link between anticholinergic drugs and risk of dementia. This study builds on this information, showing that long-term, high-dose use increases risk of some dementias, particularly vascular dementia.”
He also noted a limitation of the study, acknowledging that it's difficult to rule out whether the diseases that cause dementia might have already begun in the brains of people involved before they started taking these drugs.
Clinical Recommendations
The research team and associated experts recommend that healthcare professionals carefully weigh the risks and benefits when prescribing anticholinergic drugs, especially for middle-aged and older individuals. Alternative treatments should be considered where possible, such as different types of antidepressants or alternative treatments for bladder conditions. Regular medication reviews are also crucial.
Professor Coupland added, “The risks of this type of medication should be carefully considered by healthcare professionals alongside the benefits when the drugs are prescribed and alternative treatments should be considered where possible... We found a greater risk for people diagnosed with dementia before the age of 80 which indicates that anticholinergic drugs should be prescribed with caution in middle-aged people as well as in older people.”
It is important for patients taking these medications not to discontinue them abruptly, as this could be harmful. Patients with concerns should discuss them with their doctor to evaluate the pros and cons of their current treatment plan.
