Certain commonly used medications that have anticholinergic (AC) properties have been known to cause cognitive problems for decades. In fact, both cognitive and physical function can be affected by AC drugs. Delirium and risk of dementia have also been reported in older adults taking ACs.
Fortunately, a recent analysis showed that AC drugs did not significantly increase mortality or risk of death. But a loss of cognitive and physical function can certainly lower quality of life in a significant way for patients and their families. Understanding what AC effects are and which drugs have them can help consumers protect themselves from premature decline.
What are AC effects?
The neurotransmitter acetylcholine is necessary for the brain and nervous system to function properly. The AC effects of certain medications block acetylcholine from binding to cholinergic receptors. Central side effects include difficulty concentrating, confusion and memory impairment. Peripheral side effects of drugs containing ACs include symptoms of decreased body secretions — such as dry mouth, constipation and urinary retention — and decreased perspiration. This drying effect makes them useful in cold medicines.
What are the latest findings?
A new study used brain imaging to explore the physical effects of ACs on the brain. Researchers compared cognitive test results, brain metabolism and brain atrophy in patients who were taking anticholinergic drugs with those in patients who were not. Key findings included the following:
The authors concluded that anticholinergic medications should be avoided whenever possible.
Who may be at risk?
Risks from ACs have typically been studied in older adults. The cumulative effect, or AC burden, occurs and results in increased risk for toxicity when patients are prescribed more than one such drug. Risk factors for high AC burden in older adults include female gender, low-income level, higher comorbidity, previous hospitalization and seeing multiple different health care providers. Patients taking psychiatric medications or any medication with AC effects may also be at risk. Such patients should be particularly vigilant about the AC effects of their medications.
Many over-the-counter and prescription medications contain ACs. An AC cognitive burden scale from the Regenstrief Institute lists commonly used drugs with AC properties and is available online. Consumers can educate themselves by checking to see if their medications contain ACs or by asking their prescribing provider to calculate their AC burden.
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About the author
Dana Connolly, Ph.D., is a senior staff writer for the Sovereign Health Group, where she translates current research into practical information. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. The Sovereign Health Group is a health information resource and Dr. Connolly helps to ensure excellence in our model. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.
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