A study published today in the JAMA Internal Medicine, has highlighted the increased risk of developing dementia in patients who take anticholinergic medication at high dose over a long period of time.
The article builds on current understanding of the link by analysing a large number of patients (3434) aged 64 and over for an average 7 year period.
In each case the patients had been taking anticholinergic medication for more than 3 years and found that the relative risk of developing dementia was increased by 54% and that the risk of developing Alzheimer’s was raised by 63%.
Anticholinergic medication has several different uses, including treatment for insomnia, depression and hay fever. However, whilst there are many alternatives, non-anticholinergic treatments for those conditions, patients who are taking anticholinergics for urinary incontinence have fewer options.
This is a significant finding for clients involved in cases where they have sustained bladder injuries and need to take long term medication to manage their symptoms. For example, a high number of patients in the George Rowland litigation case being conducted by Slater and Gordon Lawyers in Liverpool, have been left with overactive bladders due to negligent treatment. For them, the only effective treatment may be anticholinergic medication.
Without such medication their condition can only be managed with incontinence pads. The effect of this study will therefore raise questions in relation to the best long term management of their condition.
The advice from Professor Shelly Gray, the lead author of the study, was:
“If providers need to prescribe a medication with anticholinergic effects because it is the best therapy for their patient they should use the lowest effective dose, monitor the therapy regularly to ensure it's working, and stop the therapy if it's ineffective."
The Alzheimer’s society does however promote a more cautious approach to the conclusions reached in the study:
“There have been concerns that regular use by older people of certain medications with anticholinergic effects, such as sleep aids and hayfever treatments, can increase the risk of dementia in certain circumstances, which this study supports. However, it is still unclear whether this is the case and if so, whether the effects seen are a result of long-term use or several episodes of short-term use. More robust research is needed to understand what the potential dangers are, and if some drugs are more likely to have this effect than others.
'We would encourage doctors and pharmacists to be aware of this potential link and would advise anyone concerned about this to speak to their GP before stopping any medication. Alzheimer's Society is funding more research in this area to better understand any connections between these and other drugs on the development of dementia.” (Dr Doug Brown, Director of Research and Development at Alzheimer's Society).
The current advice from the National Institute for Clinical Excellence in relation to managing urinary incontinence in patients with neurological disease (Clinical Guidance CG148), acknowledges that there may be complications with anticholinergics but recommends that prescribers take at least consider that there is a potential for anticholinergics to cause some central nervous system-related side effects (such as confusion).
Slater and Gordon Solicitor Christian Beadell, who represents a number of clients suffering with urinary incontinence, commented that “This study, whilst not raising anything new, does add significant weight to the discussion that has taken place in the medical profession up until now.
“There have been concerns raised about the association between anticholinergic medication and dementia for a number of years. The study group is far larger than previous studies and the finding that the risk of developing dementia is increased by over 50% will be a worry for many of our clients and pose a dilemma for them.
Many of our clients are over 65 and will be looking for reassurance that continuing to take the medication to treat their urinary incontinence is in their best interests. As with all new research, it is difficult to draw firm conclusions and we would recommend that they speak with their GP or the medical professional responsible for prescribing the medication to determine the best way forward.”
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