Evidence map›Paper›PMID 29695481›Full record

ArticleBMJ (Clinical research ed.)2018

Anticholinergic drugs and risk of dementia: case-control study.

Kathryn Richardson, Chris Fox, Ian Maidment, Nicholas Steel, Yoon K Loke, Antony Arthur, Phyo K Myint, Carlota M Grossi, Katharina Mattishent, Kathleen Bennett and 6 more

Erratum issuedOpen access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 208 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
208citing papers in PubMed, 11 pooled it
38.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

208 citing papers in PubMed, 11 syntheses or guidelines pooled it, 485 citations in OpenAlex.

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148 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors at 9 institutions in 3 countries.

Kathryn RichardsonSchool of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
Chris FoxNorwich Medical School, University of East Anglia, Norwich, UK.
Ian MaidmentSchool of Life and Health Sciences, Aston University, Birmingham, UK.
Nicholas SteelNorwich Medical School, University of East Anglia, Norwich, UK.
Yoon K LokeNorwich Medical School, University of East Anglia, Norwich, UK.
Antony ArthurSchool of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
Phyo K MyintSchool of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
Carlota M GrossiSchool of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
Katharina MattishentNorwich Medical School, University of East Anglia, Norwich, UK.
Kathleen BennettDivision of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
Noll L CampbellDepartment of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA.
Malaz BoustaniSchool of Medicine, Indiana University, Indianapolis, IN, USA.
Louise RobinsonInstitute for Ageing, Newcastle University, Newcastle upon Tyne, UK.
Carol BrayneCambridge Institute of Public Health, University of Cambridge, Cambridge, UK.
Fiona E MatthewsInstitute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
George M SavvaSchool of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
University of East Anglia · GBAston University · GBIndiana University – Purdue University Indianapolis · USNewcastle Hospitals - Campus for Ageing and Vitality · GBNewcastle University · GBPurdue University West Lafayette · USRoyal College of Surgeons in Ireland · IEUniversity of Aberdeen · GBUniversity of Cambridge · GB

Funding

Medical Research Council G0601022Medical Research Council G9901400
6 · The paper itself

Abstract

objectivesTo estimate the association between the duration and level of exposure to different classes of anticholinergic drugs and subsequent incident dementia.

designCase-control study.

settingGeneral practices in the UK contributing to the Clinical Practice Research Datalink.

participants40 770 patients aged 65-99 with a diagnosis of dementia between April 2006 and July 2015, and 283 933 controls without dementia.

interventionsDaily 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 measuresOdds ratios for incident dementia, adjusted for a range of demographic and health related covariates.

results14 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.

conclusionsA 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 registrationRegistered to the European Union electronic Register of Post-Authorisation Studies EUPAS8705.

Indexed as

AgedAged, 80 and overAntidepressive Agents, TricyclicCase-Control StudiesCholinergic AntagonistsDementiaFemaleHealth Services ResearchHumansMaleOdds RatioRisk AssessmentUnited KingdomAntidepressive Agents, TricyclicCholinergic Antagonists

Identifiers

PMID29695481
PMCPMC5915701
OpenAlexW2800521692

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.