Anticholinergic drugs and the risk of dementia: A systematic review and meta-analysis

Zheng, Yong-Bo; Shi, Le; Zhu, Xianyang; Bao, Yanping; Bai, Lijuan; Li, Jinqiao; Li, Jiajia; Han, Ying; Shi, Jie; Lü, Lin

doi:10.1016/j.neubiorev.2021.04.031

Cited by 53 publications

(44 citation statements)

References 70 publications

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“…Dementia is defined as a chronic and progressive functional and cognitive decline and it is considered a global challenge for health and social care systems 1 . Worldwide, there are currently more than 55 million people living with dementia 2 .…”

Section: Introductionmentioning

confidence: 99%

“…A number of factors are acknowledged to increase a person's risk of developing dementia, such as increasing age, a positive family history, a history of other medical conditions such as hypertension and diabetes, and lifestyle factors such as smoking and excessive alcohol consumption 3 . Reducing a person's exposure to modifiable risk factors may be the most effective approach to prevent or delay dementia 1,3,4 …”

Section: Introductionmentioning

confidence: 99%

“…Dementia is defined as a chronic and progressive functional and cognitive decline and it is considered a global challenge for health and social care systems. 1 Worldwide, there are currently more than 55 million people living with dementia. 2 A number of factors are acknowledged to increase a person's risk of developing dementia, such as increasing age, a positive family history, a history of other medical conditions such as hypertension and diabetes, and lifestyle factors such as smoking and excessive alcohol consumption.…”

Section: Introductionmentioning

confidence: 99%

“…3 Reducing a person's exposure to modifiable risk factors may be the most effective approach to prevent or delay dementia. 1,3,4 Anticholinergic drugs are commonly used in older people for the management of several medical conditions, such as Parkinson's disease, overactive bladder, gastrointestinal disorders, depression, and cardiovascular diseases. Drugs with anticholinergic activity act by blocking parasympathetic nerve action, 5,6 and can cause a wide range of side-effects including drowsiness, blurred vision, dry mouth, confusion, and hallucinations.…”

Section: Introductionmentioning

confidence: 99%

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A systematic review of interventions to reduce anticholinergic burden in older people with dementia in primary care

Shawaqfeh¹,

Hughes²,

Barry³

2022

Int J Geriat Psychiatry

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Objective: This systematic review aimed to assess the types and effectiveness of interventions that sought to reduce anticholinergic burden (ACB) in people with dementia (PwD) in primary care. Methods:One trial registry and eight electronic databases were systematically searched to identify eligible English language studies from inception until December 2021. To be eligible for inclusion, studies had to be randomised controlled trials (RCTs) or non-randomised studies (NRS), including controlled before-and-after studies and interrupted time-series studies, of interventions to reduce ACB in PwD aged ≥65 years (either community-dwelling or care home residents). All outcomes were to be considered. Quality was to be assessed using the Cochrane Risk of Bias tool for RCTs and ROBINS-I tool for NRS. If data could not be pooled for meta-analysis, a narrative synthesis was to be conducted. Results:In total, 1880 records were found, with 1594 records remaining after removal of duplicates. Following title/abstract screening, 13 full-text articles were assessed for eligibility. None of these studies met the inclusion criteria for this review. Reasons for exclusion were incorrect study design, ineligible study population, lack of focus on reducing ACB, and studies conducted outside the primary care setting. Conclusions: This 'empty' systematic review highlights the lack of interventions to reduce ACB in PwD within primary care, despite this being highlighted as a priority area for research in recent clinical guidance. Future research should focus on development and testing of interventions to reduce ACB in this patient population through high-quality clinical trials.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A systematic review of interventions to reduce anticholinergic burden in older people with dementia in primary care

Shawaqfeh¹,

Hughes²,

Barry³

2022

Int J Geriat Psychiatry

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“…Classical anticholinergic ADEs include dry mouth, decreased lower esophageal sphincter tone, urinary retention and constipation among others ( Rudolph et al, 2008 ). More concerning for older adults is that anticholinergic medication exposure has been associated with an increased risk of falls ( Ek et al, 2019 ; Shmuel et al, 2021 ), delirium ( Oudewortel et al, 2021 ; Welk et al, 2022 ), dementia ( Zheng et al, 2021 ) and poorer outcomes in those with dementia ( Bishara et al, 2021 ; Oudewortel et al, 2021 ). This has led to recommendations for older adults to avoid anticholinergic medications but as this represents such a diverse group of medications it is challenging for prescribers to recognize these agents or even know which alternatives exist.…”

Section: Introductionmentioning

confidence: 99%

A Prescribing Cascade of Proton Pump Inhibitors Following Anticholinergic Medications in Older Adults With Dementia

Trenaman

Harding²,

Bowles³

et al. 2022

Front. Pharmacol.

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Introduction: Prescribing cascade refers to use of a medication to treat a drug-related adverse event. Prescribing cascades increase medication use, cost, and risk of adverse events.Objective: Our objective was to use administrative health data to identify whether use of medications from the anticholinergic cognitive burden scale was associated with proton pump inhibitor (PPI) prescribing consistent with a prescribing cascade in older adults with dementia.Method: The cohort was comprised of Nova Scotia Seniors’ Pharmacare beneficiaries identified to have dementia and medication dispensation data recorded between 1 April 2010, or cohort entry and 31 March 2015. Anticholinergic medications from the anticholinergic cognitive burden scale (ACB) were abstracted. A look back period of 365 days identified if a PPI had been dispensed preceding anticholinergic dispensation. PPI initiation within 30, 60, 90, or 180 days of the anticholinergic medication was assessed. Demographic description of those dispensed anticholinergic medications or PPIs were reported. Risk factors for the prescribing cascade were investigated with logistic regression and Cox proportional hazards modelling including a sex-stratified analysis.Results: We identified 28,952 Nova Scotia Seniors’ Pharmacare beneficiaries with dementia and prescription dispensation data. Anticholinergic medications were frequently dispensed with 63.4% of the cohort dispensed at least one prescription for an anticholinergic medication. The prescribing cascade defined as up to 180-days between anticholinergic medication inititation and PPI dispensation, occurred in 1,845 Nova Scotia Seniors’ Pharmacare beneficiaries with dementia (incidence 6.4%). Multivariate regression showed those experiencing the prescribing cascade after initiating any anticholinergic were younger (OR 0.98, 95%CI [0.97–0.98]), less likely to live in an urban location (OR 0.82, 95%CI [0.74–0.91]), or to be men (OR 0.74, 95%CI [0.67–0.82]). Cox regression demonstrated an increased risk of starting a PPI within 180 days when initiating any medication from the ACB (HR 1.38, 95%CI [1.29–1.58]).Discussion: Regression modelling suggested that anticholinergic medications increased the risk of PPI dispensation consistent with a prescribing cascade in the cohort. The identification of the prescribing cascade in this population of older Nova Scotia Seniors’ Pharmacare Program beneficiaries with dementia using administrative health data highlights how routinely collected health data can be used to identify prescribing cascades.

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Increased anticholinergic medication use in middle‐aged and older autistic adults and its associations with self‐reported memory difficulties and cognitive decline

McQuaid,

Duane,

Ahmed

et al. 2023

Autism Research

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Many commonly used prescription and over‐the‐counter medicines have potent anticholinergic (AC) effects. Among older adults, AC medications are associated with cognitive impairment and risk for cognitive disorders, including Alzheimer's disease. Collectively, the impact of AC medications is known as anticholinergic cognitive burden (ACB). Because of the high rates of co‐occurring medical and psychiatric conditions, autistic adults may have high AC exposure and, thus, may experience elevated ACB. However, no research has characterized AC exposure or examined its associations with cognitive outcomes in autistic adults. Autistic adults (40–83 years) recruited via Simons Powering Autism Research's (SPARK) Research Match service self‐reported their medication use (N = 415) and memory complaints (N = 382) at Time (T)1. At T2, 2 years later, a subset of T1 participants (N = 197) self‐reported on decline in cognition. Medications were coded using two scales of AC potency. A high proportion (48.2%–62.9%, depending upon the AC potency scale) of autistic adults reported taking at least one medication with AC effects, and 20.5% to 26.5% of autistic adults reported clinically‐relevant levels of AC medication (potency ≥3). After controlling for birth‐sex, and age, hierarchical linear regression models showed total ACB scores and AC potency values of ≥3 predicted greater memory complaints. Logistic regression models showed that AC medicines at T1 were associated with self‐reported cognitive decline at follow‐up 2 years later. Understanding AC medications—including potentially earlier AC polypharmacy—and their impacts on cognition (e.g., dementia risk) in autistic adults is warranted.

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Anticholinergic drugs and the risk of dementia: A systematic review and meta-analysis

Cited by 53 publications

References 70 publications

A systematic review of interventions to reduce anticholinergic burden in older people with dementia in primary care

A systematic review of interventions to reduce anticholinergic burden in older people with dementia in primary care

A Prescribing Cascade of Proton Pump Inhibitors Following Anticholinergic Medications in Older Adults With Dementia

Increased anticholinergic medication use in middle‐aged and older autistic adults and its associations with self‐reported memory difficulties and cognitive decline

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