Published: Fri, April 27, 2018
Medical | By Bryan Strickland

Some antidepressants linked to dementia, study finds

Some antidepressants linked to dementia, study finds

"We found that people who had been diagnosed with dementia were up to 30% more likely to have been prescribed specific classes of anticholinergic medications", said lead study author Dr George Savva, from the University of East Anglia's School of Health Sciences.

Patients who took anticholinergics for more than a year had around a 30 per cent increased risk of dementia, researchers said. More broadly, there was a link between the use of any prescribed antidepressant, antiparkinson, or urologic drug with an anticholinergic activity burden (ACB) score of 3 (i.e. they can cross the blood brain barrier, have definite anticholinergic activity).

Results from the nested case-control study, including more than 40,000 patients with dementia, showed a significant correlation between use of anticholinergic drugs and dementia, but only for certain types of this class of drugs.

Other antidepressants (mainly selective serotonin reuptake inhibitors) with an ACB score of 1 were linked to dementia, but only close to the time of prescription, which the researchers say is unlikely to represent a direct (causal) link.

The adjusted OR for any anticholinergic drug with an ACB score of 3 being associated with dementia was 1.11 (95% CI 1.08-1.14, P 0.01), but drugs for gastrointestinal and respiratory conditions were not linked with dementia risk. There was a positive association for antidepressants with an ACB 1 score and dementia risk; no other drugs with an ACB score of 1 had this association.

In the meantime, they agree that anticholinergics in general should be avoided in older adults. Not taking the medications could have serious consequences, he said. Stronger anticholinergic drugs can sometimes have powerful side-effects, though, including memory loss and confusion, and in the past, they've been linked to dementia, although not conclusively. He told the BBC that compared with the risk posed by leading an unhealthy lifestyle, the potential risk of an anticholinergic drug contributing to the onset of the disease was "quite small".

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"Not everyone with the conditions highlighted in the study will be prescribed these particular drugs, and the researchers did not find a link between dementia risk and anticholinergic drugs used to treat allergies, stomach problems or muscle spasms". However, after a new study written by researchers at the University of East Anglia, we now face a new question: what should we do?

But particularly as treatment options for many conditions increase, the study adds more weight to the notion that physicians should be proactive about identifying alternatives to anticholinergic medications whenever possible, according to Dr. Chris Fox, a clinical senior lecturer at Norwich Medical School and a lead author on the study.

"Doctors and patients should therefore be vigilant about using anticholinergic medications".

"We studied patients with a new dementia diagnosis and looked at what anticholinergic medication they were prescribed between four and 20 years prior to being diagnosed". Levels of acetylcholine are known to be significantly lower in people with Alzheimer's disease, the most common cause of dementia in older adults, according to the Mayo Clinic.

What should patients do if they take any of these drugs?

Speaking to the BBC, Dr Ian Maidment from Aston University said it was important for people not to panic. "Carry on as usual, and if you're concerned, talk to your doctor or pharmacist".

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