Anticholinergic drugs and the risk of dementia: A systematic review and meta-analysis

Neurosci Biobehav Rev. 2021 Aug:127:296-306. doi: 10.1016/j.neubiorev.2021.04.031. Epub 2021 Apr 29.


Dementia is one of the greatest global challenges for public health; however, the relationship between anticholinergic drugs and dementia remains unclear. The aim of the present study was to perform a systematic review and meta-analysis of the predictive roles of anticholinergic drugs in dementia risk. After pooling fourteen longitudinal and case-control studies with a total of 1,564,181 subjects, anticholinergic drug use was associated with an increased risk of all-cause dementia and Alzheimer's disease. Both low and high anticholinergic drug burdens were associated with dementia. Moreover, there was a dose-dependent relationship between anticholinergic drugs and risk of dementia. With respect to the categories of anticholinergic drugs, antiparkinson, urological drugs, and antidepressants increased the risk for dementia; however, cardiovascular and gastrointestinal drugs played potentially protective roles. These findings underscore the importance of anticholinergic drugs as a potential modifiable risk factor for dementia and provide treatment priorities to optimize dementia prevention.

Keywords: Anticholinergic drug; Dementia; Meta-analysis; Risk; Systematic review.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Alzheimer Disease*
  • Cholinergic Antagonists / adverse effects
  • Dementia* / chemically induced
  • Dementia* / epidemiology
  • Humans
  • Pharmaceutical Preparations*
  • Risk Factors


  • Cholinergic Antagonists
  • Pharmaceutical Preparations