Incontinence medications and antidepressants from one of the class of anticholinergic drugs that are widely prescribed the United Kingdom and United States, are recently linked by University of East Anglia scientists with a positive diagnosis of the higher risk of dementia, even though the medicines were consumed 20 or more years before the detection of cognitive impairment. Despite this evidence, studies haven't been able to determine if the increased risk is specifically caused by the anticholinergic activity, or "whether or not the association is owing to the drugs or the underlying conditions for which they were prescribed", the authors note. These interrupt a neurotransmitter involved in regulating some of the body's most basic functions, as well as playing a role in thinking...
The study, the largest of its kind and published in the BMJ, compared the records of 40,770 patients over the age of 65 and diagnosed with dementia with 283,933 people without the condition.
They suggest that the association "could be caused by a class specific effect, or by drugs being used for very early symptoms of dementia" and they call for further research into the effects of specific drug classes.
"In the last 20 years, the number of older individuals taking five or more medicines has quadrupled", said Dr Ian Maidment, senior lecturer in clinical pharmacy at Aston University.
The exact reasons for the increased risk of dementia among those taking certain anticholinergic medications remain unclear.
A total of 14,453 (35%) cases and 86,403 (30%) controls were prescribed at least 1 anticholingeric drug with an Anticholinergic Cognitive Burden (ACB) score of 3; 1429 (3.5%) cases and 7909 (2.8%) controls were prescribed drugs with an ACB score of 2; most patients (89% of cases and 87% of controls) received a drug with an ACB score of 1 during the drug exposure period (DEP).
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Antidepressants (primarily amitriptyline, dosulepin [also known as dothiepin], and paroxetine), and urologicals (primarily oxybutynin and tolterodine) with an ACB score of 3 were consistently associated with incident dementia.
"But patients, don't suddenly stop medications".
The study also analyzed over 27 million prescriptions.
Research director Dr. Carol Routledge with the Alzheimer's Research UK said that researchers that started this study should continue looking more into the connection between "anticholinergics and dementia risk, and researchers will need to build on these findings in future studies". Not taking the medications could have serious consequences, he said. The early symptoms of dementia include depression and urinary incontinence, so it is possible the drugs were sometimes being prescribed for people who already had the early stages.
"This research is really important because there are an estimated 350 million people affected globally by depression", comments lead researcher George Savva, Ph.D., a visiting researcher at the University of East Anglia's School of Health Sciences.
The researchers also caution that patients should always consult with their physicians before changing any medication regimen.
"This study shows that some anticholinergics may cause long-term harm in addition to short-term harm".