Editor's Note: This article appeared originally in Acupuncture Today, DC's sister publication.
In the profitable world of modern health care and “polypharmacy,” certain medications, while potentially beneficial in treating various conditions, may harbor unforeseen dangers. Among these are anticholinergic drugs, which not only increase the risk of falls, but are also associated with the development dementia, particularly in older adults.
Recognizing the risks posed by this class of medications is vital for health care practitioners who can advocate for their patients to explore natural alternatives (in consultation with their primary care physicians). Additionally, using tools such as the Anticholinergic Burden Calculator can assist in evaluating and mitigating the cognitive impact of anticholinergic drugs.
Working with seniors at an independent/assisted living community with a memory unit, I witness firsthand the consequences of years of taking this class of drugs, and it’s not pretty.
Association With Dementia
Anticholinergic drugs work by blocking the action of acetylcholine, a crucial neurotransmitter involved in memory and muscle control. Despite their common use for ailments like allergies, insomnia, overactive bladder, and depression, especially prevalent among seniors, their prolonged use can detrimentally affect cognitive function and balance, leading to increased mortality rates.
Numerous studies have underscored the compelling link between anticholinergic drug use and dementia. A study in JAMA Internal Medicine revealed that long-term use of anticholinergic drugs was associated with a significantly higher risk of dementia, with the risk escalating with higher cumulative doses of these medications.1
Another study in the British Medical Journal echoed these findings, emphasizing the necessity for cautious prescribing and monitoring, particularly among older populations.2 Additionally, a Harvard Health blog highlighted a 54% higher risk of dementia associated with taking anticholinergics for the equivalent of three years or more, compared to a three-month duration.3
The mechanisms underlying the association between anticholinergic drugs and dementia are complex and not yet fully understood. However, it is believed that inhibition of acetylcholine receptors in the brain may contribute to the accumulation of amyloid plaques and neurofibrillary tangles, characteristic hallmarks of Alzheimer’s disease and other forms of dementia.
Evaluating Cost vs. Benefit
Given the potential risks associated with anticholinergic drugs, health care professionals must evaluate their benefits against cognitive effects, particularly in older patients who may be more susceptible to complications.
The Anticholinergic Burden Calculator offers a valuable tool for assessing the cumulative impact of anticholinergic medications on cognitive function. By inputting a patient’s medication list, health care professionals can generate an “anticholinergic burden score,” aiding in clinical decision-making. Figure 1 is the output given two common drugs and the output of the calculator.
The Anticholinergic Burden Calculator can provide you with an evidence-based printout to help communicate with your patient’s health care provider(s), fostering informed discussions about the potential risks and benefits of specific medications. Armed with objective data from the calculator, we can also educate patients about the importance of medication management and empower them to make informed decisions about their health care.
Safer Alternatives
Safer alternatives exist for common conditions treated with anticholinergic drugs. For instance, allergies can be managed with quercetin and bromelain,4 while anxiety and depression may respond to 5-HTP, L-tryptophan, L-theanine, St. John’s wort, folate or dehydroepiandosterone (DHEA).5 Insomnia can be addressed with CBD, L-theanine, melatonin, valerian, kava kava, chamomile, skullcap or lemon balm.6
Notably, acupuncture and traditional Chinese herbal medicine offer safe and effective treatment options for these conditions without resorting to brain-damaging anticholinergic medications.
Speaking of brain damage, Alzheimer’s disease is on the rise in the U.S. from the current estimate of 5.8 million to a whopping 14 million Americans predicted by 2060.7-8 For patients with minor dementia or Alzheimer’s, incorporating medium-chain fatty acids (MCT oil) into their diet, at a recommended dosage of two tablespoons per day, may yield notable improvements.9
Clinical Pearls
The dangers of anticholinergic drugs in potentially leading to dementia underscore the importance of vigilant medication management and risk assessment in clinical practice. Tools like the Anticholinergic Burden Calculator offer invaluable support in identifying and mitigating the cognitive risks associated with these medications.
References
When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
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A central challenge in creating our identity is that chiropractic is a method of care, not a technique or procedure. This is an important concept for us to promote. Our patients are treated with lifestyle modification, exercise, nutritional supplements, diet and a whole-body approach to accelerate the natural healing process. We are not simply CMT providers.
The results of a global survey released late last year (2023) unveiled some startling findings among medical and nursing students. The “Clinician of the Future: 2023 Education Edition” surveyed 2,212 students, of which 446 were in the United States, from 91 countries.
