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Anticholinergic drugs and risk of dementia: case-control study
Richardson K, Fox C, Maidment I, Steel N, Loke YK, Arthur A, Myint PK, Grossi CM et al.. BMJ (Clinical research ed.), 2018-04-25
Topic: Risk, prevention and care in population studies
Objectives To estimate the association between the duration and level of exposure to different classes of anticholinergic drugs and subsequent incident dementia. Design Case-control study. Setting General practices in the UK contributing to the Clinical Practice Research Datalink. Participants 40 770 patients aged 65-99 with a diagnosis of dementia between April 2006 and July 2015, and 283 933 controls without dementia. Interventions Daily defined doses of anticholinergic drugs coded using the Anticholinergic Cognitive Burden (ACB) scale, in total and grouped by subclass, prescribed 4-20 years before a diagnosis of dementia. Main outcome measures Odds ratios for incident dementia, adjusted for a range of demographic and health related covariates. Results 14 453 (35%) cases and 86 403 (30%) controls were prescribed at least one anticholinergic drug with an ACB score of 3 (definite anticholinergic activity) during the exposure period. The adjusted odds ratio for any anticholinergic drug with an ACB score of 3 was 1.11 (95% confidence interval 1.08 to 1.14). Dementia was associated with an increasing average ACB score. When considered by drug class, gastrointestinal drugs with an ACB score of 3 were not distinctively linked to dementia. The risk of dementia increased with greater exposure for antidepressant, urological, and antiparkinson drugs with an ACB score of 3. This result was also observed for exposure 15-20 years before a diagnosis. Conclusions A robust association between some classes of anticholinergic drugs and future dementia incidence was observed. This could be caused by a class specific effect, or by drugs being used for very early symptoms of dementia. Future research should examine anticholinergic drug classes as opposed to anticholinergic effects intrinsically or summing scales for anticholinergic exposure. Trial registration Registered to the European Union electronic Register of Post-Authorisation Studies EUPAS8705.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Richardson, K., Fox, C., Maidment, I., Steel, N., Loke, Y. K., Arthur, A., et al. (2018). Anticholinergic drugs and risk of dementia: case-control study. BMJ (Clinical research ed.). https://doi.org/10.1136/bmj.k1315
Vancouver
Richardson K, Fox C, Maidment I, Steel N, Loke YK, Arthur A, et al. Anticholinergic drugs and risk of dementia: case-control study. BMJ (Clinical research ed.). 2018. doi:10.1136/bmj.k1315. PMID: 29695481.
BibTeX
@article{richardson2018-29695481,
author = {Richardson, K. and Fox, C. and Maidment, I. and Steel, N. and Loke, Y. K. and Arthur, A. and Myint, P. K. and Grossi, C. M. and others},
title = {{Anticholinergic drugs and risk of dementia: case-control study}},
journal = {BMJ (Clinical research ed.)},
year = {2018},
doi = {10.1136/bmj.k1315},
pmid = {29695481},
url = {https://doi.org/10.1136/bmj.k1315}
}
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Key findings
- Results 14 453 (35%) cases and 86 403 (30%) controls were prescribed at least one anticholinergic drug with an ACB score of 3 (definite anticholinergic activity) during the exposure period.
- Dementia was associated with an increasing average ACB score.
- This result was also observed for exposure 15-20 years before a diagnosis.
Why it matters
Longer and heavier use of certain anticholinergic drugs, especially antidepressants, urological, and antiparkinson drugs, was linked to a modestly higher risk of developing dementia. This was an observational case-control study, so it cannot prove that these drugs cause dementia.
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Study details
- Study designcase-control study
- Participants770
- Evidence strengthModerate
How this study scored 71/100
Published in a leading specialty journal, and it is a case-control study. Scored zero for effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (BMJ (Clinical research ed.)) |
| Journal's citation record | 3 / 4 | BMJ: journal h-index 413 (OpenAlex, 2026-10-29) |
| Study design | 6 / 12 | A case-control study |
| 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 | 2 / 5 | 2018 — within 10 year(s) of the newest study here |
| Sample size | 2 / 4 | 770 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 500 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 50.0 citations a year over 10 year(s) since 2018 |
| Impact for its field and year | 5 / 6 | Cited 34.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 12 other studies in this library |
| Still being cited | 3 / 4 | Cited 124 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author George M. Savva: h-index 61 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Cambridge: institution h-index 1,973 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 9 institution(s) in 3 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 29695481) |
| Free to read | 2 / 2 | Free to read |
| Total | 71 / 100 | — |
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