[Effect of anticholinergic drugs on cognitive impairment in the elderly]

Rev Psiquiatr Salud Ment. Jan-Mar 2015;8(1):35-43. doi: 10.1016/j.rpsm.2013.11.003. Epub 2014 Jul 30.
[Article in Spanish]


The use of anticholinergic drugs is common in the elderly, even in people with cognitive impairment. A systematic search was conducted in PubMed (anticholinergic effects, anticholinergic and dementia) to define the effects of anticholinergic drugs in the elderly. We emphasized the search in patterns of use, the combined use with AChEIs, the measurement of the Serum Anticholinergic Activity, and the short-term and long-term cognitive effects. The conclusions are that the use of anticholinergic drugs is common in the elderly, even more so than the medical prescription of AChEIs in Alzheimer's disease. The use of anticholinergic drugs may result in cognitive impairment. In long-term use it may generate a worsening of cognitive functions. It can lead to a wrong diagnosis of mild cognitive impairment or dementia, and they can also initiate signs of dementia. Greater cognitive effects appear when there is a previous deficit, but cognitive effects from anticholinergic drugs disappear in severe dementia. The presence of ApoEɛ4 increases the vulnerability for cognitive impairment when these drugs are employed.

Keywords: Actividad anticolinérgica en suero; Alzheimer's disease; Anticholinergic drugs; Demencia; Dementia; Deterioro cognitivo leve; Enfermedad de Alzheimer; Fármacos anticolinérgicos; Mild cognitive impairment; Serum anticholinergic activity.

Publication types

  • English Abstract
  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Apolipoprotein E4 / genetics
  • Cholinergic Antagonists / adverse effects*
  • Cholinergic Antagonists / therapeutic use
  • Cholinesterase Inhibitors / therapeutic use
  • Cognition Disorders / chemically induced*
  • Cognition Disorders / diagnosis
  • Cognition Disorders / epidemiology
  • Cognition Disorders / genetics
  • Cognition Disorders / prevention & control
  • Comorbidity
  • Cross-Sectional Studies
  • Diagnostic Errors
  • Drug Utilization
  • Female
  • Genetic Predisposition to Disease
  • Humans
  • Male
  • Polypharmacy
  • Prevalence
  • Receptors, Muscarinic / drug effects
  • Receptors, Muscarinic / physiology
  • Retrospective Studies


  • Apolipoprotein E4
  • Cholinergic Antagonists
  • Cholinesterase Inhibitors
  • Receptors, Muscarinic