title: Anticholinergic and sedative medicines - prescribing considerations for people with dementia.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia. simon.bell@unisa.edu.au
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
authors.forename: Carmel
authors.initials: C
authors.lastname: Mezrani
authors.forename: Natalie
authors.initials: N
authors.lastname: Blacker
authors.forename: Tammy
authors.initials: T
authors.lastname: LeBlanc
authors.forename: Oliver
authors.initials: O
authors.lastname: Frank
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Alderman
authors.forename: Simone
authors.initials: S
authors.lastname: Rossi
authors.forename: Debra
authors.initials: D
authors.lastname: Rowett
authors.forename: Russell
authors.initials: R
authors.lastname: Shute
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000009:adverse effects; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D002800:Cholinesterase Inhibitors / Q000009:adverse effects*; D003072:Cognition Disorders / Q000139:chemically induced*; D003704:Dementia / Q000378:metabolism*; D006633:Histamine Antagonists / Q000009:adverse effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists; D002800:Cholinesterase Inhibitors; D006633:Histamine Antagonists; D006993:Hypnotics and Sedatives