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A simulation study comparing anticholinergic drug use with polypharmacy for risk of death, dementia, and delirium in UK Biobank
Jure Mur, Lucy Stirland, Graciela Muniz Terrera, Anja K. Leist. The Journals of Gerontology Series A, 2025-10-17
Topic: Risk, prevention and care in population studies
Odds ratios for death, dementia, and delirium using anticholinergic-polypharmacy pseudoscales (median = 1.09-1.10) were greater than those of general-polypharmacy pseudoscales (1.05-1.06). The added effect of anticholinergic use beyond polypharmacy was greater in adjusted models and when prescribed to participants when they were older. 35%-90% of ABS exhibited stronger effects than most pseudoscales. The models show an anticholinergic effect of drugs beyond polypharmacy or drug count, but it is small, ABS-dependent, and varies between outcomes.
Key findings
- Odds ratios for death, dementia, and delirium using anticholinergic-polypharmacy pseudoscales (median = 1.09-1.10) were greater than those of general-polypharmacy pseudoscales (1.05-1.06).
- The added effect of anticholinergic use beyond polypharmacy was greater in adjusted models and when prescribed to participants when they were older. 35%-90% of ABS exhibited stronger effects than most pseudoscales.
- The models show an anticholinergic effect of drugs beyond polypharmacy or drug count, but it is small, ABS-dependent, and varies between outcomes.
Why it matters
In this UK Biobank simulation study, anticholinergic drug use was linked to slightly higher odds of death, dementia and delirium beyond the effect of polypharmacy alone. The authors describe this extra effect as small and varying between outcomes, so it does not establish that avoiding these drugs prevents dementia.
Study details
- Study designcohort study
- Evidence strengthModerate
How this study scored 49/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (The Journals of Gerontology Series A) |
| Journal's citation record | 3 / 4 | The Journals of Gerontology Series A: journal h-index 274 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 3 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 2 / 6 | Cited 1.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 3 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Anja K. Leist: h-index 22 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of California, San Francisco: institution h-index 1,915 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 3 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41128551) |
| Free to read | 2 / 2 | Free to read |
| Total | 49 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1093/gerona/glaf232
- PubMed: 41128551
- Original source →
- Free full text: The Journals of Gerontology Series A →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Mur, J., Stirland, L., Terrera, G. M., & Leist, A. K. (2025). A simulation study comparing anticholinergic drug use with polypharmacy for risk of death, dementia, and delirium in UK Biobank. The Journals of Gerontology Series A. https://doi.org/10.1093/gerona/glaf232
Vancouver
Mur J, Stirland L, Terrera GM, Leist AK. A simulation study comparing anticholinergic drug use with polypharmacy for risk of death, dementia, and delirium in UK Biobank. The Journals of Gerontology Series A. 2025. doi:10.1093/gerona/glaf232. PMID: 41128551.
BibTeX
@article{mur2025-41128551,
author = {Mur, Jure and Stirland, Lucy and Terrera, Graciela Muniz and Leist, Anja K.},
title = {{A simulation study comparing anticholinergic drug use with polypharmacy for risk of death, dementia, and delirium in UK Biobank}},
journal = {The Journals of Gerontology Series A},
year = {2025},
doi = {10.1093/gerona/glaf232},
pmid = {41128551},
url = {https://doi.org/10.1093/gerona/glaf232}
}
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here.