“I would say that we haven't proven that these drugs cause dementia, but our results certainly reinforce concerns about this issue.” “It isn't possible to prove causation with observational data,” Dr Gray added. While this study extends previous findings on the link between anticholinergic drugs and cognition problems, it does not prove causality because it is still based on observational data. “Anticholinergic drugs do have other more recognized side effects, such as dry mouth, constipation, and urinary retention, and there has been a movement away from using them, but they are still very commonly prescribed and bought in over-the-counter products.” She said that although previous studies have linked anticholinergic agents to cognitive problems, the general population and even most doctors were unaware of the issue. “Many of these agents are used chronically, and chronic use - even at low doses - would put you in the highest risk category.” “This is not excessive use,” Dr Gray said. Even Low Doses Implicatedīut people taking just the minimum effective dose of these agents for prolonged periods qualified as having high use and were found to be at greater risk for dementia compared with those not taking such medicines.
“We found an obvious dose-response relationship between anticholinergic drug use and risk of developing dementia: the higher the usage, the greater the risk,” Dr Gray commented to Medscape Medical News. The study, published online in JAMA Internal Medicine on January 26, was conducted by a team led by Shelly Gray, PharmD, University of Washington, Seattle. They include popular antihistamines sold over the counter as sleep aids, such as diphenhydramine (Benadryl, McNeil-PPC Inc), or for allergy relief, such as chlorpheniramine oxybutynin and tolterodine for overactive bladder and the tricyclic antidepressants, such as doxepin or amitriptyline, even when used at low doses for migraine prevention or neuropathic pain. The drugs implicated are commonly used, estimated to be taken by about 20% of the older adult population for many conditions. A new study provides the strongest evidence that anticholinergic drugs may increase the risk for dementia in older adults.
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