Medscape: More Evidence Anticholinergic Meds Boost Dementia Risk

Andy · May 6, 2018

Antidepressants, drugs for Parkinson's disease, and urologic medications that have definite anticholinergic activity increase the risk of developing dementia up to 20 years after exposure, according to a large study from the United Kingdom.

"Many people use anticholinergic drugs at some point in their lives, and many are prescribed to manage chronic conditions leading to potentially long exposures.... Clinicians should continue to be vigilant with respect to the use of anticholinergic drugs, and should consider the risk of long term cognitive effects, as well as short term effects, associated with specific drug classes when performing their risk-benefit analysis," George Savva, PhD, University of East Anglia, Norwich, United Kingdom, and colleagues write.

The study was published online April 25 in the BMJ.
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https://www.medscape.com/viewarticle/896005

Esther12 · May 7, 2018

I know amitriptyline gets recommended to help with migraines, pain and sleep problems, all things that can be an issue with ME/CFS.

Little Bluestem · May 7, 2018

At one time, depression was the #1 misdiagnosis for ME/CFS. I'll bet a lot of us old-timers have been on anti-depressants.

Inara · May 7, 2018

There was a previous study about this in 2015: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2091745?resultClick=3
This new study works with larger numbers (around 40.000 patients and 280.000 controls).

Anticholinergic drugs are also "First generation antihistamines like diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton). Drugs with diphenhydramine are also often taken as a sleep aid." (https://wa-health.kaiserpermanente.org/antihistamine-increase-risk-dementia/)

Here, some anticholinergic drugs are listed:
https://www.theseniorlist.com/list-of-anticholinergic-drugs/

From the paper cited in the medscape articke:

Results 14 453 (35%) cases and 86 403 (30%) controls were prescribed at least one anticholinergic drug with an ACB score of 3 (definite anticholinergic activity) during the exposure period. The adjusted odds ratio for any anticholinergic drug with an ACB score of 3 was 1.11 (95% confidence interval 1.08 to 1.14). Dementia was associated with an increasing average ACB score. When considered by drug class, gastrointestinal drugs with an ACB score of 3 were not distinctively linked to dementia. The risk of dementia increased with greater exposure for antidepressant, urological, and antiparkinson drugs with an ACB score of 3. This result was also observed for exposure 15-20 years before a diagnosis.

Conclusions A robust association between some classes of anticholinergic drugs and future dementia incidence was observed. This could be caused by a class specific effect, or by drugs being used for very early symptoms of dementia. Future research should examine anticholinergic drug classes as opposed to anticholinergic effects intrinsically or summing scales for anticholinergic exposure.
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The authors of this study say:

However, dementia is known to be under diagnosed, with up to 50% of people with dementia undiagnosed at any time.34 Hence it is possible that some of our controls have undiagnosed dementia or early cognitive impairment. This misclassification would shrink estimated effects towards the null (odds ratio of 1) but would not remove them completely
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Medscape: More Evidence Anticholinergic Meds Boost Dementia Risk

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