The use of certain classes of anticholinergic drugs is linked to prospective dementia and cognitive decline, according to a study published in the BMJ.

Kathryn Richardson, a research fellow at the School of Health Sciences at the University of East Anglia in Norwich, UK, and associates conducted a case-control study to determine the correlation between dose and duration of certain anticholinergic drug classes and the prevalence of dementia.

The study included 40,770 participants between the ages of 65 and 99 with dementia (diagnosis between 2006 and 2015) and 283,933 participants without dementia (control cohort). The primary outcome was the odds ratio (OR) for dementia. The Anticholinergic Cognitive Burden (ACB) scale was used to define drug doses. Eligible patients in the case group were administered anticholinergic drug(s) 4 to 20 years prior to dementia diagnosis.

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Of the entire case group, 35% of patients (n=14,453) were prescribed at least one anticholinergic drug with definite anticholinergic activity, recorded with an ACB score of 3; 30% of control participants (n=86,403) scored 3 on the ACB scale for the same criteria (OR, 1.11).

An increased ACB score was positively correlated with increased likelihood of dementia. Dementia was also positively correlated with increased exposure to antidepressants, urologic, and antiparkinson drugs with anticholinergic activity but not in gastrointestinal drugs.

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“A robust association between some classes of anticholinergic drugs and future dementia incidence was observed,” reported the authors. “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.


Richardson K, Fox C, Maidment I, et al. Anticholinergic drugs and risk of dementia: case control study. BMJ. 2018;361:k1315