Dementia Could Be Increased By Some Drugs

27 April, 2018, 01:15 | Author: Judith Dennis
  • Science has linked anticholinergic drugs with cognitive impairment and an increased risk of dementia

Amitriptyline was in the news in February, named as the most effective of the antidepressants in a study.

A new study by the University of East Anglia found that some classes of anticholinergic drugs, particularly those used to treat depression, Parkinson's and urinary incontinence, carry a higher risk than others.

Drugs were scored according to their anticholinergic activity using the Anticholinergic Cognitive Burden (ACB) scale. It is already known that they can cause short-term confusion and raise people's risk of a fall. In addition, "many studies have linked anticholinergic drug use with concurrent or short term cognitive effects, but few have examined associations of long term anticholinergic exposure; the latter tend to report positive associations".

The researchers warn that the increasing tendency for older people to be taking a cocktail of drugs for different conditions may be part of the problem. Nevertheless, the team claims, the findings are signficant enough to warrant reduced prescribing anticholinergics, where possible "With many medicines having some anticholinergic activity, one key focus should be de-prescribing", states study co-researcher Ian Maidment, Ph.D., senior lecturer in clinical pharmacy at Aston University in the United Kingdom.

"The focus should be on de-prescribing at least some medicines. In the meantime, I strongly advise patients with any concerns to continue taking their medicines until they have consulted their doctor or pharmacist".

Anticholinergic drugs function by blocking the effects of acetylcholine, a chemical released by nerve cells to send signals to other nerves and muscles.

The researchers, who report their findings in the British Medical Journal, investigated GP records for more than 40,000 people over the age of 65 with dementia and almost 300,000 without dementia.

Previous literature has linked anticholinergic use to dementia, however these studies have been limited by their inability to determine if the increased risk is specific to the drug or the underlying conditions for which they were prescribed.

It analyzed data from the medical record of 40,770 patients between the ages of 65 - 99 that had been diagnosed with dementia between a period of April 2006 - July 2015.

"Having untreated depression is also a risk as people can die from that, so it is a question of balancing risks", he added. It could be that these medications are being prescribed for very early symptoms indicating the onset of dementia.

Anticholinergic antidepressants have been found to be linked with dementia, even when taken up to 20 years before a diagnosis.

The researchers do stress that patients prescribed anticholinergic drugs shouldn't just stop taking their medicines. "Not taking prescribed drugs could have serious consequences". The study's findings were published this week in BMJ.

But those individuals taking other classes of anticholinergics - including those used for asthma and gastrointestinal issues - were not at an increased risk of developing dementia compared with matched controls, the study found.

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.

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

"But the headline claim that some drugs, especially antidepressants, can cause dementia up to 20 years later should be looked at closely".

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