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Use of Anticholinergic Drugs Does Not Increase Risk for Dementia in Parkinson’s Disease Patients

Concern that Anticholinergics Could Potentially Worsen Cognition in PD Unfounded, According to New Research Reported in the Journal of Parkinson’s Disease

January 5, 2016
Recent evidence has shown a greater risk of dementia, in particular Alzheimer’s disease (AD), in individuals using anticholinergic medications regularly. These drugs are widely used by older adults to treat bladder dysfunction, mood, and pain, and many of them are available without prescription. Since these drugs are often used to treat both motor symptoms and non-motor symptoms in patients with Parkinson’s Disease (PD), there is concern for increased risk of dementia. Contrary to expectations, a study in the current issue of the Journal of Parkinson’s Disease determined that the cognitive performance of PD patients taking anticholinergic medications did not differ from those who did not.

Principal investigator David J. Burn, Director of the Institute of Neuroscience and Professor of Movement Disorder Neurology at Newcastle University, UK, explained, “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.”

Using data from the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation – Parkinson’s Disease study (ICICLE-PD), a twin center longitudinal observational study of the anatomical, biochemical, and genotypic mechanisms underlying the evolution of persons developing dementia (PDD), the investigators studied 195 PD patients and 84 control patients. The PD patients’ detailed medication history, including over-the-counter drugs, was evaluated according to the Anticholinergic Drug Scale (ADS). Each drug was classified on a scale from 0 to 3 according to no (0), mild (1), moderate (2) or high (3) anticholinergic activity. Total usage from baseline to 18-month follow up was used to produce a total burden score. Those with ADS scores greater than or equal to 1 were in the PD+ADS group while those with ADS scores equal to 0 were designated PD-ADS.

Comparison of the PD+ADS (n = 83) and PD-ADS (n = 112) groups revealed no differences with respect to global cognition or assessments of attention, memory, and executive function at 18 months. The proportion of mild cognitive impairment (MCI) was similar in those with and without anticholinergic drug use. Although a greater proportion of PD subjects were taking anticholinergic medications, the total drug burden did not differ between the PD patients and controls.

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NOTES FOR EDITORS

Anticholinergic Load: Is there a Cognitive Cost in Early Parkinson’s Disease?” by Alison J. Yarnall, Rachael A. Lawson, Gordon W. Duncan, David P. Breen, Tien K. Khoo, David Brooks, Roger A. Barker, John-Paul Taylor, and David J. Burn(DOI 10.3233/JPD-150664), Journal of Parkinson’s Disease, Volume 5, Issue 4, published by IOS Press.

To obtain the full text of this study and additional information contact Daphne Watrin, IOS Press, at +31 20 688 3355, d.watrin@iospress.nl. Journalists wishing to interview the authors should contact the Newcastle University Media Relations office, Helen Rae at Helen.Rae@newcastle.ac.uk or Karen Bidwell at karen.bidwell@ncl.ac.uk.

ABOUT THE JOURNAL OF PARKINSON’S DISEASE (JPD)

Launched in 2011 the Journal of Parkinson’s Disease is dedicated to providing an open forum for original research in basic science, translational research and clinical medicine that will expedite our fundamental understanding and improve treatment of Parkinson’s disease. The journal is international and multidisciplinary and aims to promote progress in the epidemiology, etiology, genetics, molecular correlates, pathogenesis, pharmacology, psychology, diagnosis and treatment of Parkinson’s disease. It publishes research reports, reviews, short communications, and letters-to-the-editor and offers very rapid publication and an affordable open access option. 

ABOUT IOS PRESS

Commencing its publishing activities in 1987, IOS Press serves the information needs of scientific and medical communities worldwide. IOS Press now (co-)publishes over 100 international journals and about 75 book titles each year on subjects ranging from computer sciences and mathematics to medicine and the natural sciences.

IOS Press continues its rapid growth, embracing new technologies for the timely dissemination of information. All journals are available electronically and an e-book platform was launched in 2005.

Headquartered in Amsterdam with satellite offices in the USA, Germany, India and China, IOS Press has established several strategic co-publishing initiatives. Notable acquisitions included Delft University Press in 2005 and Millpress Science Publishers in 2008.