Anticholinergic Action is Rarely a Good Thing

Overview

Journal Ther Adv Psychopharmacol

Specialty Psychiatry

Date 2023 Sep 13

PMID 37701892

Authors

Delia Bishara

Affiliations

Soon will be listed here.

Abstract

The evidence for the risks associated with anticholinergic agents has grown considerably in the last two decades. Not only are they associated with causing peripheral side effects such as dry mouth, blurred vision and constipation, but they can also cause central effects such as cognitive impairment; and more recently, they have consistently been linked with an increased risk of dementia and death in older people. This paper reviews the evidence for the associations of anticholinergic agents and the risk of dementia and increased mortality in dementia.

Citing Articles

Understanding the medication regimens associated with anticholinergic burden in older people's mental health services in the UK.

Barnes T, Bishara D, Burns A, Myint P, Rendora O, Edokpolor Pernia E BJPsych Open. 2024; 10(5):e167.

PMID: 39359152 PMC: 11536223. DOI: 10.1192/bjo.2024.788.

References

Mur J, Russ T, Cox S, Marioni R, Muniz-Terrera G . Association between anticholinergic burden and dementia in UK Biobank. Alzheimers Dement (N Y). 2022; 8(1):e12290. PMC: 9005668. DOI: 10.1002/trc2.12290. View

Welk B, McArthur E . Increased risk of dementia among patients with overactive bladder treated with an anticholinergic medication compared to a beta-3 agonist: a population-based cohort study. BJU Int. 2020; 126(1):183-190. DOI: 10.1111/bju.15040. View

Ziad A, Olekhnovitch R, Ruiz F, Berr C, Begaud B, Goldberg M . Anticholinergic drug use and cognitive performances in middle age: findings from the CONSTANCES cohort. J Neurol Neurosurg Psychiatry. 2018; 89(10):1107-1115. PMC: 6166611. DOI: 10.1136/jnnp-2018-318190. View

Bell B, Avery A, Bishara D, Coupland C, Ashcroft D, Orrell M . Anticholinergic drugs and risk of dementia: Time for action?. Pharmacol Res Perspect. 2021; 9(3):e00793. PMC: 8177062. DOI: 10.1002/prp2.793. View

Scullion J . The development of anticholinergics in the management of COPD. Int J Chron Obstruct Pulmon Dis. 2007; 2(1):33-40. PMC: 2692120. DOI: 10.2147/copd.2007.2.1.33. View

Taylor C, Youngblood M, Catellier D, Veith R, Carney R, Burg M . Effects of antidepressant medication on morbidity and mortality in depressed patients after myocardial infarction. Arch Gen Psychiatry. 2005; 62(7):792-8. DOI: 10.1001/archpsyc.62.7.792. View

Richardson K, Fox C, Maidment I, Steel N, Loke Y, Arthur A . Anticholinergic drugs and risk of dementia: case-control study. BMJ. 2018; 361:k1315. PMC: 5915701. DOI: 10.1136/bmj.k1315. View

Lopez-Alvarez J, Sevilla-Llewellyn-Jones J, Aguera-Ortiz L . Anticholinergic Drugs in Geriatric Psychopharmacology. Front Neurosci. 2019; 13:1309. PMC: 6908498. DOI: 10.3389/fnins.2019.01309. View

Watanabe S, Fukatsu T, Kanemoto K . Risk of hospitalization associated with anticholinergic medication for patients with dementia. Psychogeriatrics. 2018; 18(1):57-63. DOI: 10.1111/psyg.12291. View

10.

Tan E, Eriksdotter M, Garcia-Ptacek S, Fastbom J, Johnell K . Anticholinergic Burden and Risk of Stroke and Death in People with Different Types of Dementia. J Alzheimers Dis. 2018; 65(2):589-596. DOI: 10.3233/JAD-180353. View

11.

Zheng Y, Shi L, Zhu X, Bao Y, Bai L, Li J . Anticholinergic drugs and the risk of dementia: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2021; 127:296-306. DOI: 10.1016/j.neubiorev.2021.04.031. View

12.

Coupland C, Hill T, Dening T, Morriss R, Moore M, Hippisley-Cox J . Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study. JAMA Intern Med. 2019; 179(8):1084-1093. PMC: 6593623. DOI: 10.1001/jamainternmed.2019.0677. View

13.

Lieberman 3rd J . Managing anticholinergic side effects. Prim Care Companion J Clin Psychiatry. 2005; 6(Suppl 2):20-3. PMC: 487008. View

14.

Ah Y, Suh Y, Jun K, Hwang S, Lee J . Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population-based study. Basic Clin Pharmacol Toxicol. 2018; 124(6):741-748. DOI: 10.1111/bcpt.13184. View

15.

Bishara D, Perera G, Harwood D, Taylor D, Sauer J, Funnell N . Centrally-acting anticholinergic drugs- associations with mortality, hospitalisation and cognitive decline following dementia diagnosis in people receiving antidepressant and antipsychotic drugs. Aging Ment Health. 2021; 26(9):1747-1755. DOI: 10.1080/13607863.2021.1947967. View

16.

Rodriguez-Ramallo H, Baez-Gutierrez N, Prado-Mel E, Alfaro-Lara E, Santos-Ramos B, Sanchez-Fidalgo S . Association between Anticholinergic Burden and Constipation: A Systematic Review. Healthcare (Basel). 2021; 9(5). PMC: 8153334. DOI: 10.3390/healthcare9050581. View

17.

Bishara D, Perera G, Harwood D, Taylor D, Sauer J, Stewart R . The anticholinergic effect on cognition (AEC) scale-Associations with mortality, hospitalisation and cognitive decline following dementia diagnosis. Int J Geriatr Psychiatry. 2020; 35(9):1069-1077. DOI: 10.1002/gps.5330. View

18.

Tansey E . Henry Dale and the discovery of acetylcholine. C R Biol. 2006; 329(5-6):419-25. DOI: 10.1016/j.crvi.2006.03.012. View

19.

McMichael A, Zafeiridi E, Ryan M, Cunningham E, Passmore A, McGuinness B . Anticholinergic drug use and risk of mortality for people with dementia in Northern Ireland. Aging Ment Health. 2020; 25(8):1475-1482. DOI: 10.1080/13607863.2020.1830028. View

20.

Volpicelli L, Levey A . Muscarinic acetylcholine receptor subtypes in cerebral cortex and hippocampus. Prog Brain Res. 2003; 145:59-66. DOI: 10.1016/S0079-6123(03)45003-6. View