NHS doctors are prescribing medicines associated with a higher risk of dementia without consistently informing patients about the potential danger. Research has linked anticholinergic drugs to an increased likelihood of developing the condition, prompting experts to call for clearer warnings before treatment begins.
Anticholinergics are used to manage a wide range of health problems, including bladder conditions, depression, allergies, Parkinson’s disease and chronic obstructive pulmonary disease (COPD). More than four million people aged 65 and over in the UK are currently prescribed at least one of these medicines. Taking several anticholinergic drugs at the same time may further increase dementia risk, and doctors are being urged to consider safer alternatives where appropriate.
The Times reports that the possible connection with dementia is often absent from the side effects discussed when the medicines are prescribed.
Lucy Pollock, a leading geriatrician from Somerset, said patients should receive more complete information. “I feel very strongly about giving patients the right information about this. We don’t audit it routinely, and there’s often no flag in prescribing systems when an anticholinergic is prescribed.”
She added: “We can’t wait for more evidence to build up because millions more people will take these medicines over the next few decades.”
Research published in 2023 by scientists at the University of Nottingham found that patients taking bladder anticholinergics, including oxybutynin, were 18% more likely to develop dementia than people who were not using the drugs.
Tony Avery, one of the study’s authors, said in 2020 that action should be taken immediately. “We should act now and advise colleagues not to use anticholinergics associated with dementia for bladder symptoms when there are alternatives that appear to be safer,” he warned.
However, a review by the Medicines and Healthcare Products Regulatory Agency (MHRA) this year concluded that the available evidence was not sufficiently strong to warrant regulatory action.
While studies frequently report an association between anticholinergic medicines and dementia risk, regulators have so far been hesitant to require the possible link to be added to prescription information leaflets.
Alison Cave, the MHRA’s chief safety officer, said: “It is already known that taking more than one anticholinergic medicine increases the risk of experiencing side-effects, so these medicines should be limited where possible in older adults.
“Patients should continue taking their medicines as prescribed and, if they have any concerns, discuss them with a healthcare professional.”
An NHS spokesman said: “Anticholinergic drugs must always be prescribed in line with clinical guidance and with the patient’s or carer’s agreement, following a discussion to ensure the risks and benefits are fully considered and understood.
“The NHS is committed to stopping medicines when they are no longer necessary. It carried out 3.6 million medication reviews last year to help ensure that people living with frailty were prescribed only the medicines they needed. With thousands of pharmacists now working in GP practices, we expect that number to rise.”
