Cognitive Risks of Anticholinergics in the Elderly
Cognitive Risks of Anticholinergics in the Elderly
As the population ages, there will be a greater proportion of individuals with cognitive impairment. The risk of dementia increases dramatically after the age of 65 years, with nearly half of the 'oldest-old' (greater than 85 years) diagnosed with Alzheimer's disease. The aging population is exposed to an increasing number of medications with uncertain anticholinergic activity, including prescriptions, over-the-counter products and nutraceuticals, placing them at significant risk of unintended cognitive impairment. Clearly, there needs to be improved methods of quantifying the unique antimuscarinic potential of drugs taken by the elderly to aid the clinician in determining their additive effects. Until that time, clinicians must rely on clinical scales (e.g., ADS) and consensus guidelines (e.g., Revised Beers Criteria) to identify, monitor and minimize a patient's anticholinergic burden (Table 1).
Conclusion & Future Perspective
As the population ages, there will be a greater proportion of individuals with cognitive impairment. The risk of dementia increases dramatically after the age of 65 years, with nearly half of the 'oldest-old' (greater than 85 years) diagnosed with Alzheimer's disease. The aging population is exposed to an increasing number of medications with uncertain anticholinergic activity, including prescriptions, over-the-counter products and nutraceuticals, placing them at significant risk of unintended cognitive impairment. Clearly, there needs to be improved methods of quantifying the unique antimuscarinic potential of drugs taken by the elderly to aid the clinician in determining their additive effects. Until that time, clinicians must rely on clinical scales (e.g., ADS) and consensus guidelines (e.g., Revised Beers Criteria) to identify, monitor and minimize a patient's anticholinergic burden (Table 1).
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