Anticholinergic and sedative medicines: prescribing considerations for people with dementia

Background: Older people with dementia may be particularly susceptible to cognitive impairment associated with anticholinergic and sedative medicines. This impairment may be misattributed to the disease process itself. 

Objective: This review examines clinical considerations associated with using anticholinergic and sedative medicines in people with dementia or incipient cognitive impairment. It highlights issues associated with concomitant use of cholinesterase inhibitors and anticholinergic medicines, and pharmacotherapy of conditions that commonly occur in people with dementia. 

Discussion: Use of medicines with anticholinergic or sedative properties may result in adverse events by increasing the overall anticholinergic or sedative load. Patients may benefit from clinicians reviewing the anticholinergic load of the current medicine regimen before the initiation of cholinesterase inhibitors or memantine. Reducing the number and dose of anticholinergic and sedative medicines may improve cognitive function and reduce the likelihood of adverse events.