A new systematic review and meta-analysis confirms a link between use of anticholinergic medications and dementia.

Taking anticholinergic agents for 3 months or longer increased the risk for incident dementia by an average of 46% compared with nonuse based on a meta-analysis of 6 studies involving 645,865 patients across 5 countries, Roger R. Dmochowski, MD, MMHC, professor of urologic surgery at Vanderbilt University Medical Center in Nashville, Tennessee, reported in Neurourology and Urodynamics and at ICS 2020 Online, the virtual conference of the International Continence Society. The drugs exert their effects by blocking the action of the neurotransmitter acetylcholine. Dementia risk (including Alzheimer disease, Lewy body dementia, vascular dementia, and other subtypes) increased with longer drug exposure. Both male and female patients and those younger and older than 65 years were at risk.

This increased risk also applied to anticholinergic medications frequently used to treat overactive bladder (OAB). Use of bladder antimuscarinics, such as darifenacin, fesoterodine, flavoxate, oxybutynin, propiverine, solifenacin, tolterodine, and trospium, for 3 or more months was associated with 21% to 65% higher odds of dementia, depending on exposure category. Whether the use of anticholinergic agents is a reversible risk factor is an important area of future research, Dr Dmochowski noted.

Most of the 21 studies included in the full systematic review reported an increased neurological risk with anticholinergic use, either overall or for at least 1 anticholinergic exposure category, including 8 of 9 incident dementia studies, 4 of 4 incident Alzheimer disease studies, 2 of 2 incident mild cognitive impairment studies, and 7 of 11 cognitive impairment/decreased performance studies.


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“The findings from our systematic literature review and meta-analysis shine a light on what data and anecdotal evidence has demonstrated for many practicing physicians: ongoing use of anticholinergics to treat OAB comes with an increased risk,” Dr Dmochowski stated in a news release. “These findings underscore the need for medicines that can treat conditions such as OAB without the potential cognitive risks associated with anticholinergic agents.

“It is essential that health care providers work with their patients to determine an appropriate treatment plan.”

Disclosure: This clinical trial was supported by Urovant Sciences. Please see the original reference for a full list of authors’ disclosures.

References

Dmochowski RR, Thai S, Iglay K, et al. Increased risk of incident dementia following use of anticholinergic agents: A systematic literature review and meta‐analysis. Neurourol Urodynamics. doi:10.1002/nau.24536

Examining the Risk of Cognitive Effects Associated with Anticholinergic Agents [press release]. Urovant Sciences; November 19, 2020.

Cognitive effects associated with anticholinergic agents. Presented at: ICS 2020 Online, November 19-22, 2020. Abstract 151.