‘Anticholinergic burden’ may be a prognostic factor for future cognitive decline in older adults

The authors of this Cochrane review advise caution should be taken when prescribing anticholinergic drugs in older adults as anticholinergic drug use was shown to be consistently associated with future cognitive decline or dementia.

Results suggest that cognitively unimpaired older adults who use drugs defined as “definitely” anticholinergic by the Anticholinergic Cognitive Burden scale may have more than twice the odds of developing future cognitive decline or dementia than non‐users, independent of age, sex and comorbidities. Moreover, a relationship between severity of anticholinergic burden and future dementia appears to be apparent – odds of developing future cognitive decline or dementia may rise as extent of anticholinergic burden increases. People with a severe anticholinergic burden might see their odds of cognitive decline or dementia increase by as much as 227%.

If the observed link demonstrated in this review proves to be causal, these exposure rates would imply anticholinergics meaningfully contribute to the global dementia burden.