Elderly people with dementia often tolerate drugs less favorably than healthy older adults. Reasons for this include:

  • An increased sensitivity to certain side effects
  • Difficulty with adhering to drug regimens
  • Decreased ability to recognize and report adverse events

Elderly people with dementia are also more prone than healthy elderly persons to develop drug-induced cognitive impairment.1 Medications with strong anticholinergic (AC) side effects, such as sedating antihistamines, are well-known for causing acute cognitive impairment in people with dementia.1-3

What Are Anticholinergic (AC) Drugs Used For?

Anticholinergic-like effects, such as urinary retention and dry mouth, have also been identified in drugs not typically associated with major AC side effects, eg. narcotics and benzodiazepines.These drugs are also important causes of acute confusional states. When used appropriately, the CIs (donepezil [Aricept], rivastigmine [Exelon], and galantamine [Razadyne, Reminyl]) may slow the decline of cognitive and functional impairment in people with dementia. In order to achieve the best therapeutic effect, CIs should ideally not be used in combination with ACs.1,2

Factors That Determine If A Patient Will Develop Cognitive Impairment When Exposed To AC Drugs

  • Total AC load (determined by number of AC drugs and dosage)
  • Baseline cognitive function
  • Individual patient’s bodily functions like renal and liver function

What Does Jura Care Village Say About Anticholinergic Drugs?

Evidence suggests that the use of Anticholinergic drugs plays a key role in the development of Alzheimer’s disease. Sadly, there are countless care facilities throughout the world who rely on AC drugs too easily and too early, predominantly used as a sedative for their patients/residents. Not only this, but AC drugs are prescribed by medical professionals too easily. That said, there is a place for drug therapy however we would like to emphasize this always to be the last resort. “The first step is always to look at the method of care.” Says Marlene van Niekerk, MD of the Jura Care Village. “How can I care better? What can I try? What will work? These are the questions one should ask when someone with a form of Dementia is difficult to care for.” 

When selecting drug therapy for patients with dementia, the use of AC medications should be avoided, or at least limited to medications within a therapeutic class that have the least AC adverse effects. The following table summarizes medications associated with causing worsening cognitive function in patients with dementia. Therapeutic alternatives are included when possible.



(1) Roe CM, Anderson MJ, Spivack B. Use of anticholinergic medications by older adults with dementia. J Am Geriatr Soc 2002;50:836-42.

(2) Cooper JW, Burfield AH. Ask the Expert Q&A. Are cholinesterase inhibitors of any value in patients with dementia who are taking medications with anticholinergic effects, such as those used to manage urinary incontinence? Annals of LongTerm Care 2003;11:50-2.

(3) Han L, McCusker J, Cole M, et al. Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med 2001;161:1099-105.

(4) Miyasaki JM, Martin W, Suchowersky O, et al. Practice parameter: initiation of treatment fo Parkinson’s disease: an evidence-based review. Neurology 2002;58:11-17.

(5) Motsinger CD, Perron GA, Lacy TJ. Use of atypical antipsychotic drugs in patients with dementia. Am Fam Physician 2003;67:2335-40.

(6) Potentially harmful drugs in the elderly: Beers list and more. Pharmacist’s Letter/Prescriber’s Letter 2008;23(9):230907.

(7) Oral muscle relaxants. Pharmacist’s Letter/Prescriber’s Letter 2006;22(12):221206.

(8) Olanow CW, Watts RL, Koller WC. An algorithm (decision tree) for the management of Parkinson’s disease (2001): treatment guidelines. Neurology 2001;56(Suppl 5):S1-S88.

(9) Yap P, Tan D. Urinary incontinence in dementia-a practical approach. Aust Fam Phys 2006;35:23741.

Source: Dementia Care Strategies