In Parkinson’s disease, dementia risk does not increase with anticholinergic drugs

In Parkinson’s disease (PD), dementia risk does not increase with anticholinergic drugs. Other studies have found a greater risk of Alzheimer’s disease (AD) and dementia associated with the anticholinergic drugs used to treat pain, bladder dysfunction, and mood. In Parkinson’s disease, anticholinergic drugs are used to improve motor and non-motor symptoms, and even though there was a growing concern that these drugs could increase the risk of dementia in PD patients, a recent study has shown otherwise.

Principal investigator David J. Burn said, “This is the first study to explore an association between anticholinergic burden and mild cognitive impairment (MCI) in PD participants, and is timely, given recent research demonstrating cumulative anticholinergic burden and risk of AD in the general population. Our assessment will help determine whether patients prescribed medication with anticholinergic activity are more likely to develop dementia, and hence allow early targeted intervention to reduce future risk.”

The researchers used data from Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation and looked at 195 Parkinson’s disease patients and 84 healthy controls. The detailed medication history for the former was evaluated based on the Anticholinergic Drug Scale, measuring the anticholinergic activity of each drug from zero (no activity) to 3 (high activity).

No cognition disparity was found between Parkinson’s disease patients and the healthy controls, even with more Parkinson’s patients taking anticholinergic drug. These findings suggest that the use of this type of medication does not increase the risk of Parkinson’s disease.

Anticholinergic drugs not beneficial for dementia patients

If a patient already has dementia, the use of anticholinergic drugs is not recommended, according to research. Researcher Ann Kolanowski said, “In this study, people on anticholinergic medications had worse attention and physical function, and a longer stay (at the rehab facility) by four days, when compared to patients not on these medications.”

The researchers looked at 99 patients over the course of one month or until the patient was discharged from the rehabilitation facility. All patients had delirium and dementia, and were over the age of 65. Cognition and physical function were assessed daily.

Anticholinergic drugs were ranked by their impact on cognition. Twenty-five percent of participants were taking a drug with a moderate to severe anticholinergic effect, and 15 were not taking any anticholinergics. Patients who took anticholinergic drugs with a moderate to severe effect performed poorly on cognitive tests and had a deteriorated physical function.

“For people with dementia, the loss of physical function is a major risk factor for permanent institutionalization, and contributes heavily to the national burden of healthcare costs. The goal of post-acute care is to optimize function. For people with dementia, appropriate anticholinergic medication management may help achieve rehabilitation goals and reduce the cost of care,” concluded the researchers.

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Sources:
http://news.psu.edu/story/389729/2016/01/28/research/anticholinergics-may-not-be-best-choice-rehab-patients-dementia
https://www.sciencedaily.com/releases/2016/01/160105101849.htm
http://content.iospress.com/articles/journal-of-parkinsons-disease/jpd150664