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NICE: GPs should avoid anticholinergic drugs which raise dementia risk

NICE has urged GPs to avoid some classes of anticholinergic medicines because they increase patients’ risk of developing dementia.

It comes as a study, published earlier this year, found long-term use of some drugs with anticholinergic modes of action were associated with a raised dementia risk.

In response, a medicines evidence commentary published by NICE suggested these medicines should be ‘avoided’ in mid- and later life patients.

The study analysed the association between the duration and level of exposure to different classes of anticholinergic drugs – which block the neurotransmitter acetylcholine in the nervous system – and the resulting incidence of dementia.

It found that the risk of dementia increased with greater exposure to antidepressant, urological and antiparkinson drugs, while gastrointestinal drugs were not distinctively linked to the condition.

NICE’s commentary said: ‘A large, nested, case-control study in UK general practices found that some classes of anticholinergic medicines were significantly associated with an increase in incidence of dementia.

‘Medicines with less anticholinergic burden should be chosen, where possible, and patients made aware of the risk and benefits.

‘The NICE guidance on multimorbidity and also on medicines optimisation recommends that a screening tool, such as the STOPP/ START tool in older people, can be used to identify medicines-related safety concerns.’

NICE expert Professor Louise Allan, professor of geriatric medicine at the University of Exeter Medical School, explained that this is the first time there has been evidence for long-term use of anticholinergic medicines being linked with incidence of dementia, rather than short-term.

She said: ‘This paper cannot comment on whether withdrawal of these medicines at the onset of symptoms of dementia would make a difference to the person’s symptoms, but it does nevertheless seem sensible to avoid these medicines in people with cognitive symptoms.’

Professor Allan added: ‘What it does suggest is that anticholinergic antidepressants, antiparkinsonian and urological medicines should be avoided as part of midlife and late life approaches to prevention of dementia.’

Back in 2014, researchers urged GP to review the use of such medications in their elderly patients, with a focus on those with dementia, after they found an association with declines in both physical and cognitive function.


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