A widely used class of drugs called anti-cholinergics shows strong evidence of causing cognitive and physical decline in older adults—and yet they are still widely used by seniors.
Anti-cholinergic drugs are frequently prescribed for conditions including high blood pressure, dizziness, diarrhea, asthma and depression, and even found in over-the-counter allergy, cold and cough medications. A number of studies in recent years have looked at the possible connection between anti-cholinergics and ‘age-related’ decline in mental and physical performance, and now a new analysis of all the available evidence has found that the drugs do indeed appear to be related to worsening cognitive ability and physical function. Of 46 studies (including a total of over 60,000 participants) included in the analysis, 25 of 33 (77%) that measured cognitive ability found that it declined in proportion to the amount of anti-cholinergic drug a person had been taking, and 5 of 8 studies that measured physical performance (62.5%) found that anti-cholinergics were related to a lower ability of people to perform everyday physical tasks like walking and getting dressed. Although the numbers aren’t available for US populations, as many as half of seniors in the UK are thought to be taking a drug with anti-cholinergic effects. Some brain cells rely on choline to process information, so it’s possible that the negative effects of these drugs are related to fact that they interfere with these cells, but more research is needed before we know for sure why anti-cholinergics appear to be especially harmful to the elderly. In the meantime, the researchers are calling on physicians to use caution when prescribing these drugs to older patients and to monitor them carefully. (Source: Age and Ageing, 2014; DOI: 10.1093/ageing/afu096)