A link between anticholinergic drug use and cognitive impairment was recently observed from observational studies on randomized clinical trials. Regenstrief Institute research scientists examined whether anticholinergic drugs can lead to dementia and if cholinergic neurotransmission can be improved. Commentary published in JAMA Internal Medicine explains how researchers identify anticholinergic drug use as a potential public health concern and risk factor for dementia.
Anticholinergic-based medicines work by inhibiting the neurotransmitter acetylcholine and used for the treatment of anxiety, depression, and certain types of pain as well as allergies or sleep problems. They are frequently prescribed to older adults.
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"Though we learn about potential risk factors through observational studies, the best way to define a causal relationship between anticholinergics and dementia requires a prospective, randomized trial," states lead author, Dr. Noll Campbell. "In conducting such a trial, we can also learn about the risks and benefits of deprescribing medications, including the impact on symptom control, withdrawal or other adverse events, quality of life, and healthcare utilization."
In the commentary, researchers call for the opportunity to understand the cognitive benefit of deprescribing anticholinergics. They identify ideal drug targets for reducing the anticholinergic burden which includes: “(1) high risk of harm, (2) commonly used and (3) existence of an alternative drug to manage the patient's medical condition, if necessary.”
"Clinicians, health policy makers and patients need to understand the benefits and harms of deprescribing anticholinergics," Dr. Campbell added. "The bottom line is that we need as much high-quality evidence to understand risks and benefits of deprescribing a medication as we have to prescribe it. At the same time, we need to be exploring alternative medications which are known not to harm the aging brain and that patients can afford."