Information you need to know

Executive Summary JAMA article: Drug Exposure and the Risk of Dementia

Primary Aim: To determine the association between cumulative anticholinergic use and the risk of dementia.

Study Design: “Nested case-control” of 58,769 patients with dementia and 225,574 control patients.

Subjects: 55 years or older and matched on age, sex, and timing of diagnosis. Excluded patients include those with Parkinson’s, multiple sclerosis and other types of dementia associated with specific conditions.

Methods: Used prescription data for 56 drugs with strong an/cholinergic properties and calculated the total standard daily doses (TSDDs) of the exposure in the 1-11 years prior to the diagnosis of dementia or equivalent date in matched controls.

Findings: There were statistically significant increases in the risk of dementia as compared to controls even at the lowest exposure levels, which increased with higher exposures (9 to 52%). Approximately 10% of dementia diagnoses can be attributed to anticholinergic drug exposure which represents a substantial proportion of cases. Specifically, for OAB anticholinergic medications the risk increased by 20% in the lowest exposure group and up to 65% in the medium and highest exposure groups.

This was one of the highest risk increases noted of any of the anticholinergic medications with only anticholinergic having a slightly higher risk. These associations were even stronger when the diagnosis was made prior to 80 years of age.

Implications: There is a significant increased risk of dementia with an/cholinergic exposure, even at the lowest levels.

Exposure to bladder anticholinergics poses one of the highest risks of dementia and the association is even higher if the diagnosis was made at a younger age.

These results are consistent with prior published data and suggests that anticholinergic medications should be utilized with precaution in patients over 55 years. This would be especially true for conditions that are not life-threatening and when effective alternate therapies exist.