The Risks of Side Effects of Certain Meds in Seniors

Many medicines taken by older people have anticholinergic effects that can influence brain activity. They include antidepressants like amitriptyline, imipramine and clomipramine, tranquilizers like chlorpromazine and trifluoperazine, bladder medications such as oxybutinin, and antihistamines such as chlorphenamine. 

A large study addressing the problem was launched by the University of East Anglia, UK, supported by the British Medical Research Council, and reported in the Journal of the American Geriatrics Society.  There were more than 13,000 men and women aged 65 and above in the 2-year study.  Baseline use of possible or definite drugs with anticholinergic properties were recorded, and a Mini-Mental State Examination (MMSE) done to determine cognitive ability level.  The MMSE was repeated after 2 years.  The drugs taken were scored for their anticholinergic activity, using a recognized scale – the Anticholinergic Cognitive Burden Scale.

At baseline, 47% of the participants used a drug with possible anticholinergic properties, and 4% one with definite anticholinergic properties. Use of definite anticholinergic drugs was found, after 2 years, to be associated with a significantly greater fall in MMSE score (-0.33 points) than in people not taking such meds. Use of possible anticholinergic drugs had no such increase in deteriorating cognition. 

Mortality at 2 years was greater for those taking definite and possibly anticholinergic drugs than in those taking no such drugs – it was increased 1.68 times for definite and 1.56 times for possible users, respectively.

It’s well known that anticholinergic drug effects can impair cognition.  But this is the first time that such drugs have been linked with an increased death rate.  For those of us over 65, it’s important that we are aware of these risks; we should read the package insert for both prescribed and over-the-counter (OTC) meds, and consider if an alternative is available.  Ask your doctor, who should be able to help.