Investigating the Impact of Anticholinergic Drugs on Memory Clinic

Introduction

The aging UK population and increases in life expectancy are contributing to an increase in the prevalence of dementia. A high anticholinergic burden (ACB) is associated with adverse prognosis in dementia. The aim of this service evaluation was to assess the prevalence of anticholinergic medications on referral to memory clinics in Cardiff and Vale memory assessment service.

Methods

A retrospective cross-sectional study was conducted which evaluated the referral letters of 200 new patients referred to memory clinic in 2024. Data extracted from the referral letters included patient demographics, current medications, and comorbidities. Each patient’s anticholinergic burden was calculated using the Anticholinergic Cognitive Burden scale. The ACB scores were then analysed in relation to demographic and clinical variables to explore potential associations.

Results

Anticholinergic medications were prescribed to 65% of patients referred to memory clinic. 22% of patients were classified as having a high risk ACB score (≥3), 12% were medium risk (2), and 66% were low risk (≤1). Patients in the high-risk group were prescribed significantly more medications on average than those in the low-risk group (10.39 vs. 4.64; p < 0.0001). The most common contributing drugs to the total ACB were omeprazole, metformin, lansoprazole, and amitriptyline. Higher ACB scores were associated with younger patient age (mean age: high risk = 73.18; low risk = 79.77; p < 0.001). Comorbidities most strongly associated with a higher risk ACB score included type 2 diabetes, neuropathic pain, overactive bladder, and recurrent urinary tract infections (p < 0.05).

Conclusions

A high number of patients referred to memory clinics have a high or medium risk ACB score despite it worsening symptoms of dementia. We aim to undertake educational sessions to improve knowledge of anticholinergic burden amongst colleagues and promote medication reviews prior to memory clinic referral.