Anticholinergic drugs and risk of dementia: Time for action?

Bell, Brian; Avery, Anthony; Bishara, Delia; Coupland, Carol; Ashcroft, Darren; Orrell, Martin

Abstract

Evidence suggests that the prescription of bladder anticholinergics is increasing. Recent studies have accentuated concerns about whether certain prescribed medications could increase risk of dementia, including anticholinergic drugs, and specifically anticholinergics used for bladder symptoms. Nevertheless, it can be difficult to draw together the evidence to review the case for possible causation. Recognising this issue in 1965, Bradford-Hill set out nine criteria to help assess whether evidence of a causal relationship could be inferred between a presumed cause and an observed effect. In this commentary, we explore the extent to which associations between anticholinergics and dementia satisfy the Bradford-Hill criteria and examine the potential implications. First, we look at studies that have examined the relationship between anticholinergic drugs with urological properties (bladder drugs) and the onset of dementia, and then present those studies which specifically focus on the cognitive effects of bladder drugs that affect muscarinic receptors in the brain versus the bladder on older people along with suggestions for future research. We also discuss the risks and benefits of these drugs for treating overactive bladder. If it can be shown that certain medications carry a specific risk of dementia, it is possible that initiatives to change prescribing could become a key tool in reducing the risk of dementia and may be easier to implement than some lifestyle changes.

Citation

Bell, B., Avery, A., Bishara, D., Coupland, C., Ashcroft, D., & Orrell, M. (2021). Anticholinergic drugs and risk of dementia: Time for action?. Pharmacology Research and Perspectives, 9(3), Article e00793. https://doi.org/10.1002/prp2.793

• Journal Article Type: Commentary
• Acceptance Date: Apr 21, 2021
• Online Publication Date: Jun 4, 2021
• Publication Date: 2021-06
• Deposit Date: Apr 26, 2021
• Publicly Available Date: Jun 4, 2021
• Journal: Pharmacology Research and Perspectives
• Electronic ISSN: 2052-1707
• Publisher: Wiley Open Access
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 3
• Article Number: e00793
• DOI: https://doi.org/10.1002/prp2.793
• Keywords: Anticholinergic drugs; Dementia
• Public URL: https://nottingham-repository.worktribe.com/output/5496819
• Publisher URL: https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793