Anticholinergic and benzodiazepine medication use and risk of incident dementia: a UK cohort study

Carlota M. Grossi, Kathryn Richardson* (Corresponding Author), Chris Fox, Ian Maidment, Nicholas Steel, Yoon K. Loke, Antony Arthur, Phyo Kyaw Myint, Noll Campbell, Malaz Boustani, Louise Robinson, Carol Brayne, Fiona E. Matthews, George M. Savva

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Citations (Scopus)
8 Downloads (Pure)


Background Studies suggest that anticholinergic medication or benzodiazepine use could increase dementia risk. We tested this hypothesis using data from a UK cohort study. Methods We used data from the baseline (Y0), 2-year (Y2) and 10-year (Y10) waves of the Medical Research Council Cognitive Function and Ageing Study. Participants without dementia at Y2 were included (n = 8216). Use of benzodiazepines (including nonbenzodiazepine Z-drugs), anticholinergics with score 3 (ACB3) and anticholinergics with score 1 or 2 (ACB12) according to the Anticholinergic Cognitive Burden scale were coded as ever use (use at Y0 or Y2), recurrent use (Y0 and Y2), new use (Y2, but not Y0) or discontinued use (Y0, but not Y2). The outcome was incident dementia by Y10. Incidence rate ratios (IRR) were estimated using Poisson regression adjusted for potential confounders. Pre-planned subgroup analyses were conducted by age, sex and Y2 Mini-Mental State Examination (MMSE) score. Results Dementia incidence was 9.3% (N = 220 cases) between Y2 and Y10. The adjusted IRRs (95%CI) of developing dementia were 1.06 (0.72, 1.60), 1.28 (0.82, 2.00) and 0.89 (0.68, 1.17) for benzodiazepines, ACB3 and ACB12 ever-users compared with non-users. For recurrent users the respective IRRs were 1.30 (0.79, 2.14), 1.68 (1.00, 2.82) and 0.95 (0.71, 1.28). ACB3 ever-use was associated with dementia among those with Y2 MMSE> 25 (IRR = 2.28 [1.32–3.92]), but not if Y2 MMSE≤25 (IRR = 0.94 [0.51–1.73]). Conclusions Neither benzodiazepines nor ACB12 medications were associated with dementia. Recurrent use of ACB3 anticholinergics was associated with dementia, particularly in those with good baseline cognitive function. The long-term prescribing of anticholinergics should be avoided in older people.
Original languageEnglish
Article number276
Number of pages10
JournalBMC Geriatrics
Publication statusPublished - 21 Oct 2019

Bibliographical note

Availability of data and materials
Data can be shared through application. For further information please refer to the application forms on the website

We would like to thank the MRC CFAS study group for data collection and management. We are also grateful to all respondents, their families and their primary care teams for their participation in the MRC CFAS. We would like to thank Mr. Barry Plumpton, Mrs. Ann McLauchlan, Mrs. Barbara di Vita, and Mrs. Gloria Swan for providing valuable assistance in interpretation and oversight as Alzheimer’s Society Research Network Volunteers.

This work was supported by the UK Alzheimer’s Society [AS-PG-2013-017]. The funders had no role in the design of the study or the interpretation of the findings.


  • Alzheimer disease
  • Cognition
  • Dementia
  • Cohort study
  • Benzodiazepines
  • Cholinergic antagonists


Dive into the research topics of 'Anticholinergic and benzodiazepine medication use and risk of incident dementia: a UK cohort study'. Together they form a unique fingerprint.

Cite this