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Centrally Acting Anticholinergic Drugs Used for Urinary Conditions Associated with Worse Outcomes in Dementia

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Bibliographical note

Funding Information: No specific funding was received for this project. DB and RS are part funded by the National Institute for Health Research (NIHR), United Kingdom Biomedical Research Center at South London and Maudsley NHS Foundation Trust and King's College London, United Kingdom.RS declares research support received in the last 36 months from Janssen, GSK and Takeda. Funding Information: No specific funding was received for this project. DB and RS are part funded by the National Institute for Health Research (NIHR), United Kingdom Biomedical Research Center at South London and Maudsley NHS Foundation Trust and King’s College London, United Kingdom. Funding Information: DT receives research funding from Janssen Pharmaceuticals, United Kingdom and Lundbeck and has received speaking honoraria from Janssen, Lundbeck, Sunovion, and Recordati. Publisher Copyright: © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

Objectives: To investigate the associations between central anticholinergic burden and mortality, hospitalization, and cognitive impairment in people with dementia prescribed anticholinergic drugs for urinary symptoms. Design: Retrospective cohort study. Setting and Participants: Patients diagnosed with dementia receiving anticholinergic medication for bladder conditions (N = 540), assembled from a large healthcare database. Methods: Central anticholinergic burden related to bladder drugs was estimated using the anticholinergic effect on cognition scale. Data were linked to national mortality and hospitalization data sources, and serially recorded Mini-Mental State Examination scores were used to investigate cognitive decline. Results: Patients had a median survival of 4.1 years. Urinary drugs with a high anticholinergic effect on cognition score (tolterodine, oxybutynin) were associated with a 55% increased mortality risk (hazard ratio 1.55; 95% confidence interval 1.19‒2.01; P =.001) compared with drugs with low or no central anticholinergic burden (darifenacin, fesoterodine, trospium, mirabegron, solifenacin). Cognitive decline over a 24-month period around diagnosis was only detectable in the high central anticholinergic group, but there was no significant difference in cognitive trajectories between the high and low/no anticholinergic bladder drug groups. No increase of emergency hospitalization risk was seen in relation to central anticholinergic burden. Conclusions and Implications: Urinary drugs with high central anticholinergic burden cause more harm than those acting peripherally and should be avoided in people with dementia. Further research is needed to test whether centrally acting anticholinergic agents in general cause worse outcomes in dementia.

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