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Anticholinergic drugs and risk of dementia: case-control study

BMJ 2018; 361 doi: (Published 25 April 2018) Cite this as: BMJ 2018;361:k1315

Rapid Response:

Re: Anticholinergic drugs and risk of dementia: case-control study

As a clinical psychologist, I am hoping that these results may make general practitioners and psychiatrists think twice before prescribing anticholinergic medication, especially to older adults. It may help see an increase in referrals to IAPT services, and to therapy services in secondary mental health services/inpatient units, in order to try non-pharmacological interventions to treat symptoms of depression and anxiety. However, the fact remains that many older adults presenting with depressive symptoms, especially in secondary mental health and inpatient units, may not benefit solely from psychological intervention, but would benefit [as prescribed by NICE guidelines] from a combination of the two.

I am concerned that the media attention this paper has received may make the findings of the study ambiguous; it could shift the focus away from the fact that it was the correlation/association being reported rather than a cause-effect relationship.

It is well established that depression in older adults, especially in those with MCI, if left untreated, can hasten the process of developing a dementia - leaving symptoms untreated may be detrimental to those affected [not only due to the impact on their lives, but also in terms of increasing the risk of developing a dementia].

What would the implications be in terms of treating those who present with moderate to severe depression, with significant risks, who may not be suitable or amenable for 1:1 work or group therapy? [please let the answer not be ECT!]

Can the authors comment on whether those with symptoms of depression and anxiety [maybe even milder presentations like dysthymia] who did not receive any pharmacological treatment developed dementia or not within the same [or extended] timeframe?

It has been a while since I bid adieu to empirical research, but I do remember enough to see that the controls used were probably not the ideal comparison group. It would have been more interesting and maybe more relevant to know the comparison between those who were on anticholinergic drugs vs. those were not treated despite a diagnosis of depression/anxiety, i.e. to explore the relationship between affective states and it's impact on cognitive function.

This article has been widely reported in the media - I am worried that older adult service users, who are in general loath to adding yet another medication to their treatment regimen, may find this research paper as evidence to discontinuing their anti-depressants.

Competing interests: No competing interests

26 April 2018
Viba Pavan Kumar
Clinical Psychologist
Birmingham Solihull Mental Health Foundation Trust
BSMHFT, Birmingham