Medicines specifically prescribed for their anticholinergic properties (eg.oxybutynin, benzhexol and benztropine) are well recognised by clinicians.Use of medicines with anticholinergic or sedative properties may result in adverse events by increasing the overall anticholinergic or sedative load.Patients may benefit from clinicians reviewing the anticholinergic load of the current medicine regimen before the initiation of cholinesterase inhibitors or memantine.This review examines clinical considerations associated with using anticholinergic and sedative medicines in people with dementia or incipient cognitive impairment.It highlights issues associated with concomitant use of cholinesterase inhibitors and anticholinergic medicines, and pharmacotherapy of conditions that commonly occur in people with dementia.
Causes of dementia include Alzheimer disease, dementia with Lewy bodies, frontotemporal dementia, vascular dementia and Parkinson disease.
Older people with dementia may be particularly susceptible to cognitive impairment associated with anticholinergic and sedative medicines.
This impairment may be misattributed to the disease process itself.
Clinically significant adverse events Use of medicines with anticholinergic properties in older people is associated with impaired physical and cognitive function.
However, clinicians may be less aware that some medicines prescribed for other purposes also have anticholinergic properties These include the inhaled anticholinergics, ipratropium and tiotropium bromide when prescribed in their usual therapeutic doses.
Even medicines with minor anticholinergic properties may contribute to unwanted central and peripheral adverse events if used in combination with other agents with anticholinergic effects.