A fair number of medications have anticholinergic properties. In general, anticholinergic-induced cognitive impairment is considered reversible on discontinuation of anticholinergic therapy. However, a few studies suggest that anticholinergics may be associated with an increased risk for dementia.
This study examined whether cumulative anticholinergic use is associated with a higher risk for incident dementia. 3434 participants 65 years or older with no dementia at project entry were studied for a mean follow-up of 7.3 years. During this time period 23.2% developed dementia and of these, 79.9% developed Alzheimer disease. The most common anticholinergic classes used were tricyclic antidepressants, first-generation antihistamines, and bladder antimuscarinics. A 10-year cumulative dose-response relationship was observed for dementia and Alzheimer disease. The study concluded that higher cumulative anticholinergic use is associated with an increased risk for dementia. Efforts to increase awareness about this potential medication-related risk are important, as well as minimizing anticholinergic use over time.
Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, Yu O, Crane PK, Larson EB: Cumulative Use of Strong Anticholinergics and Incident Dementia, A Prospective Cohort Study. JAMA Intern Med. [Epub ahead of print January 26, 2015. doi:10.1001/jamainternmed.2014.7663]

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