Intended for healthcare professionals


Anticholinergic drugs and dementia in older adults

BMJ 2018; 361 doi: (Published 25 April 2018) Cite this as: BMJ 2018;361:k1722
  1. Shelly L Gray, professor1,
  2. Joseph T Hanlon, professor2
  1. 1School of Pharmacy, University of Washington, Seattle, WA, USA
  2. 2Department of Medicine (Geriatrics), School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
  1. Correspondence to: S L Gray slgray{at}

Should we be concerned?

Drugs with anticholinergic activity (also known as anticholinergics) prevent acetylcholine from binding to muscarinic and nicotinic receptors, which might result in numerous adverse drug events, especially in older adults. Anticholinergics, used by 10-27% of older adults,123 manage diverse health conditions such as overactive bladder, seasonal allergies, and depression. It is well established that these drugs can cause temporary short term impairment in cognition, including attention and reaction time.4 Over the past decade, however, mounting evidence suggests that overall use of anticholinergics might be associated with an increased risk of dementia.567

In a linked paper, Richardson and colleagues (doi:10.1136/bmj.k1315) examine the association between anticholinergics (as defined by the 2012 version of the Anticholinergic Cognitive Burden (ACB) scale) and dementia risk by performing a rigorous nested case-control study using data from within the UK Clinical Practice Research Datalink.8 …

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