NHS doctors prescribing drugs linked to dementia without warning patients of risk

Across the UK, more than four million people aged 65 and over are currently taking at least one anticholinergic medication — a category of drugs associated with a heightened risk of dementia — yet are typically not informed of this potential danger.

These medicines, which function by blocking acetylcholine, a chemical essential for communication between brain and muscle cells, are widely used to treat bladder conditions, depression, Parkinson's disease and various psychiatric disorders.

Despite multiple studies linking their use to an elevated likelihood of developing dementia, patient information leaflets routinely list side effects such as dry mouth, constipation, falls and blurred vision while omitting any reference to the dementia connection.

NHS prescribing figures reveal a dramatic surge in their use, with annual anticholinergic prescriptions rising from 2.6 million in 2005 to 6.2 million last year — an increase of more than 138 per cent.

Lucy Pollock, a prominent geriatrician based in Somerset, stressed the importance of transparency with patients. "I feel very strongly about giving patients the right information about this. We don't audit it routinely and there's often no flag in prescribing systems when an anticholinergic is prescribed," she said.

She also warned against delay, arguing: "We can't wait for more evidence to build up because millions more people will take these medicines over the next few decades."

The absence of systematic monitoring is compounded by the fact elderly patients are disproportionately likely to be prescribed several anticholinergic drugs simultaneously, compounding the risk of adverse effects.

Among the most commonly dispensed high-risk anticholinergics are amitriptyline, used for depression and nerve pain; the antipsychotics clozapine and olanzapine; and bladder medications including oxybutynin, solifenacin and tolterodine.

Research published in 2023 by a team at the University of Nottingham examined the health records of close to one million patients over 55 in England, tracking them for up to 13 years prior to a dementia diagnosis. The findings revealed users of bladder anticholinergics such as oxybutynin faced an 18 per cent greater chance of developing dementia compared with non-users.

Crucially, the study also found patients prescribed mirabegron — a non-anticholinergic bladder drug — showed no statistically meaningful rise in dementia risk, suggesting safer treatment options already exist.

One of the study's authors, Tony Avery, now serves as NHS England's national clinical director for prescribing. Back in 2020, while still a professor at Nottingham, he urged in an editorial "we should act now and advise colleagues not to use anticholinergics associated with dementia for bladder symptoms when there are alternatives that appear to be safer".

The issue forms part of a broader overprescribing crisis affecting older patients across England. Nearly eight million people over 50 are now taking five or more prescription drugs — the threshold known as "polypharmacy", at which side-effect risks escalate — while more than two million are on 10 or more medications.

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Beyond individual anticholinergic drugs, commonly prescribed medicines such as metformin for diabetes and furosemide for fluid retention can combine with anticholinergics to create a cumulative effect termed the "anticholinergic burden".

NICE guidelines state this burden should be actively reduced and regularly reviewed, particularly for frail patients, The Sunday Times reports.

Yet awareness among clinicians remains patchy. In 2022, the Royal College of Surgeons of Edinburgh flagged widespread prescribing of these drugs without adequate consideration of alternatives.

The British Geriatrics Society followed up last year, pointing to hospital audits showing not all trusts were properly assessing the impact of anticholinergics on vulnerable inpatients.

The MHRA, the UK's medicines watchdog, conducted a review of the dementia risk associated with bladder anticholinergics this year. While it acknowledged the risk could not be ruled out, the regulator determined existing evidence was insufficient to mandate any changes — a position that leaves patient leaflets unchanged despite the association being repeatedly identified in peer-reviewed research.

Alison Cave, the MHRA's chief safety officer, said: "It is already known that taking more than one anticholinergic medicine increases the risk of experiencing side-effects, so these medicines should be limited where possible in older adults."

She added patients should not stop their medications but should raise any concerns with their healthcare professional.

An NHS spokesman said anticholinergic drugs must be prescribed in accordance with clinical guidance and with patient agreement, noting 3.6 million medication reviews were carried out last year to ensure frail patients received only necessary prescriptions.

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