Wednesday, 17 October, 2018

Some antidepressants may be linked to dementia

Two million Britons take medicine that may increase the risk of dementia, depression and Parkinson's by a third Everyday drugs raise the risk of dementia
Johnnie Parks | 26 April, 2018, 20:28

The study, led by a team at the University of East Anglia in the United Kingdom, involved a collaboration between teams in the United Kingdom, USA and Ireland."These findings make it clear that clinicians need to carefully consider the anticholinergic burden of their patients and weigh other options", claims Malaz Boustani, M.D., MPH, a Regenstrief Institute and Indiana University (IU) Center for Aging Research investigator, and co-author of the researchers' published paper in the BMJ.

For drugs with an anticholinergic cognitive burden (ACB) score of 3, the adjusted OR increased from 1.07 (95% CI 1.02-1.12, P 0.01) for patients with 14 to 89 daily doses of these drugs to 1.31 (95% CI 1.22-1.41, P 0.01) for those with over 1,460 daily doses. Previous studies that linked anticholinergic to dementia have been limited for not being able to determine whether it was the drug or the condition itself that caused dementia.

'And the association with dementia increases with greater exposure to these types of medication.' Doug Brown of the Alzheimer's Society, which sponsored the research, said: 'Guidelines for doctors say that anticholinergic drugs should be avoided for frail older people due to their impact on memory and thinking, but doctors should consider these new findings for all over-65s as long-term use could raise the risk of dementia'.

The researchers suggested that doctors must take care when prescribing anticholinergic drugs and consider the risks, particularly when prescribing to Parkinson's patients.

The study relied on data from from the UK's Clinical Practice Research Database to identify 40,770 patients aged 65 to 99 who were diagnosed with dementia between April 2006 and July 2015.

Millions of people are taking routine medication that may significantly increase their risk of developing dementia later in life, scientists are warning.

Commonly used anticholinergic prescription drugs include Levsin, Donnatal, Pamine, Librax, Symax Duotab, Bentyl and Transderm-Scop.

"But the headline claim that some drugs, especially antidepressants, can cause dementia up to 20 years later should be looked at closely".

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"In total, there were 27 million prescription events that we were looking at over that period", Savva said.

Anticholinergic drugs are created to block the neurotransmitter acetylcholine in the central or peripheral nervous system, and have diverse actions, dependent on the site, the researchers explain.

Dr Noll Campbell, a collaborator and co-author on the paper, said: "These results suggest we should prioritise safer alternatives to anticholinergic medications long before symptoms of dementia are recognised".

But the new study is the first to look at different classes of anticholinergic medications, according to Savva.

'Doctors and patients should therefore be vigilant about using anticholinergic medications.

The proportion of dementia cases diagnosed with depression at the start of drug treatment was 12 percent, but rose to 20 percent during use. Further research is needed to understand possible reasons for this link.

One in five people on anti-depressants are prescribed anticholinergics - the most common being amitriptyline.

Dr Ian Maidment, Senior Lecturer in Clinical Pharmacy at Aston University and lead pharmacist on the study, said: "We already have strong evidence that anticholinergics cause confusion and in the short-term will potentially worsen the symptoms of dementia. Carry on as usual, and if you're concerned, talk to your doctor or pharmacist".

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