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Cohort Study
Cognitive adverse effects and brain deterioration associated with use of anticholinergic activity medicines in older adults
  1. Prasad S Nishtala,
  2. Mohammed Saji Salahudeen
  1. School of Pharmacy, University of Otago, Dunedin, New Zealand
  1. Correspondence to: Dr Prasad S Nishtala, School of Pharmacy, University of Otago, PO Box 56, Dunedin 9054, New Zealand; prasad.nishtala{at}

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Older people are particularly vulnerable to adverse cognitive effects and risk of dementia following exposure to medicines with anticholinergic activity;1 however, the biological basis for these effects remains unclear.2 The risk of anticholinergic adverse effects increases with age, polypharmacy, comorbidities, pre-existing cognitive impairment, cholinergic neuronal degeneration and changes in pharmacokinetic and pharmacodynamic properties. This study examined whether medicines with anticholinergic activity alter brain glucose metabolism, and the impact this has on brain structure, function and cognitive decline.


This retrospective cohort study involved 402 participants from the Alzheimer's Disease Neuroimaging Initiative …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.