Anticholinergic Drugs Linked to Incident Dementia and Cognitive Decline

Sarfaroj Khan 

July 08, 2020


  • Anticholinergic drug use, particularly long-term use, was associated with increased dementia incidence and cognitive decline.

  • However, no causal relationship was established, as studies were observational with considerable risk of bias.

Why this matters

  • Prescribers should carefully consider the potential benefits and harms when initiating and continuing anticholinergic drugs.

Study design

  • 26 studies including 621,548 participants met eligibility criteria after a search across electronic databases.

  • Funding: Alzheimer’s Society UK.

Key results

  • The pooled OR for any use of drugs with definite anticholinergic activity and incident dementia was 1.20 (95% CI, 1.09-1.32; I2, 86%).

  • Short-term (≥90 days; OR, 1.23; 95% CI, 1.17-1.29) and long-term (≥365 days; OR, 1.50; 95% CI, 1.22-1.85; I2, 90%) anticholinergic use were associated with incident dementia.

  • Greater cognitive decline was consistently seen in patients taking anticholinergic drugs (standardised mean difference, 0.15; 95% CI, 0.09-0.21) with no statistically significant difference for mild cognitive impairment (OR, 1.24; 95% CI, 0.97-1.59).


  • Heterogeneity among included studies.

  • Risk of bias and residual confounding.


Pieper NT, Grossi CM, Chan WY, Loke YK, Savva GM, Haroulis C, Steel N, Fox C, Maidment ID, Arthur AJ, Myint PK, Smith TO, Robinson L, Matthews FE, Brayne C, Richardson K. Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis. Age Ageing. 2020 Jun 29 [Epub ahead of print]. doi: 10.1093/ageing/afaa090. PMID: 32603415 Abstract.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.


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