The DOI matches its Crossref record; 44 of the 44 references it cites were found in a registry or an index; 22 of the 46 sources its claims cite were checked for support.
Anticholinergic drugs and risk of dementia: case-control study
Open accessAbstract
Objectives: To estimate the association between the duration and level of exposure to different classes of anticholinergic drugs and subsequent incident dementia. Design: Case-control study. Setting: General practices in the UK contributing to the Clinical Practice Research Datalink. Participants: 40 770 patients aged 65-99 with a diagnosis of dementia between April 2006 and July 2015, and 283 933 controls without dementia. Interventions: Daily defined doses of anticholinergic drugs coded using the Anticholinergic Cognitive Burden (ACB) scale, in total and grouped by subclass, prescribed 4-20 years before a diagnosis of dementia. Main outcome measures: Odds ratios for incident dementia, adjusted for a range of demographic and health related covariates. Results: 14 453 (35%) cases and 86 403 (30%) controls were prescribed at least one anticholinergic drug with an ACB score of 3 (definite anticholinergic activity) during the exposure period. The adjusted odds ratio for any anticholinergic drug with an ACB score of 3 was 1.11 (95% confidence interval 1.08 to 1.14). Dementia was associated with an increasing average ACB score. When considered by drug class, gastrointestinal drugs with an ACB score of 3 were not distinctively linked to dementia. The risk of dementia increased with greater exposure for antidepressant, urological, and antiparkinson drugs with an ACB score of 3. This result was also observed for exposure 15-20 years before a diagnosis. Conclusions: A robust association between some classes of anticholinergic drugs and future dementia incidence was observed. This could be caused by a class specific effect, or by drugs being used for very early symptoms of dementia. Future research should examine anticholinergic drug classes as opposed to anticholinergic effects intrinsically or summing scales for anticholinergic exposure. Trial registration: Registered to the European Union electronic Register of Post-Authorisation Studies EUPAS8705.
Overview
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Written from the paper’s full text.
TL;DR
In a UK Clinical Practice Research Datalink nested case-control study, certain anticholinergic drug classes with definite anticholinergic activity were associated with incident dementia, with associations persisting up to 20 years after exposure. The strongest signals were for antidepressant, urological, and antiparkinson drugs with an Anticholinergic Cognitive Burden (ACB) score of 3, while gastrointestinal and cardiovascular anticholinergics were not positively associated.
Key findings
- Among 40,770 dementia cases and 283,933 controls, 14,453 (35%) cases and 86,403 (30%) controls were prescribed at least one ACB score 3 drug; the adjusted odds ratio for any ACB score 3 drug was 1.11 (95% CI 1.08 to 1.14).
- Dose-response was seen for ACB score 3 drugs: adjusted OR 1.31 (1.22 to 1.41) for >1460 DDDs versus none, and average ACB score >5.0 had adjusted OR 1.28 (1.19 to 1.36). ACB score 1 drugs showed no dose-response.
- By class, ACB score 3 antidepressants (OR 1.11, 1.08 to 1.14), urologicals (OR 1.18, 1.13 to 1.23), and antiparkinsons (OR 1.29, 1.11 to 1.50) were associated with dementia; gastrointestinal ACB score 3 drugs were not positively associated (OR 0.94, 0.89 to 0.99).
- Associations persisted 15-20 years before diagnosis for any ACB score 3 drug (OR 1.17, 1.10 to 1.24), antidepressants with ACB score 3 (OR 1.19, 1.10 to 1.29), and urologicals with ACB score 3 (OR 1.27, 1.09 to 1.48).
Methods
- Nested case-control study using UK general practices in the Clinical Practice Research Datalink; cases were patients aged 65-99 with a dementia diagnosis between April 2006 and July 2015, matched to up to seven controls on sex, year of birth within three years, years of up-to-standard data history, and practice-level deprivation.
- Anticholinergic exposure was measured as defined daily doses during a drug exposure period ending four years before the index date, classified by the ACB scale and grouped by drug class; exposure categories were 0, 1-13, 14-89, 90-364, 365-1459, and >1460 DDDs.
- Conditional logistic regression estimated adjusted odds ratios for incident dementia, with covariates measured at the start and end of the exposure period; prespecified secondary analyses examined drug class, time before diagnosis, average ACB score, and sensitivity analyses including a new-user design and the Anticholinergic Drug Scale.
Limitations
- Stated: dementia is underdiagnosed (up to 50%), so some controls may have undiagnosed dementia or early cognitive impairment, which would bias estimates toward the null; surveillance bias is possible but would be expected across drug classes; anticholinergic activity is difficult to assess and scales differ; adherence is unknown, over-the-counter drugs are not recorded, and DDDs have limitations; residual or unmeasured confounding cannot be excluded; primary care records lack detailed lifestyle and demographic information; estimates generalise to those surviving at least four years after initial anticholinergic exposure.
- Evident from the design/text: observational case-control data cannot establish causality, and the authors note that class-specific associations could reflect underlying indications, prodromal symptoms, or differences in blood-brain barrier penetration rather than a direct anticholinergic effect.
Model-written summary. Check it against the paper before relying on it.
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Claims the paper makes
22 of 46 cited sources checked · 11 supported · 0 flagged · accuracy not yet measured
Every source the paper cites for this claim was checked and supports it.
In the paper
“CPRD data are broadly representative of the UK population in terms of sex, age, and ethnicity.22”
§ Anticholinergic drugs and risk of dementia: case-control study > Methods > Study design
What the sources say
- Supportedcites [22] source
The Strengths and weaknesses section, under “Representativeness,” says CPRD patients are broadly representative of the UK population in age and sex and comparable to the UK census in ethnicity. This supports all three characteristics in the citing sentence. (LLM, conf=0.95)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“However, dementia is known to be under diagnosed, with up to 50% of people with dementia undiagnosed at any time.34”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Strengths and weaknesses of the study
What the sources say
- Partly supportedcites [34] sourceExperimental — accuracy not yet measured
The Discussion (page unavailable) says clinically diagnosed dementia rates are lower than rates found through case finding because some people with early dementia may not have been diagnosed. It does not give an estimate that up to 50% of people with dementia are undiagnosed at any time. (LLM, conf=0.86)
Load-bearingStrength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Our findings are consistent with these studies, particularly a US cohort study of 3434 participants monitored over an average of seven years.12”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Strengths and weaknesses in relation to other studies
What the sources say
- Supportedcites [12] source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“However, studies with longer follow-up periods have often failed to detect an association, or have reported weaker associations, between midlife depression and dementia in later life.1 20”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
What the sources say
- Could not verifycites [1] sourceExperimental — accuracy not yet measured
The Abstract mentions depression as a potentially modifiable dementia risk factor, but does not address whether longer follow-up weakens or eliminates an association between midlife depression and later dementia. Searches for midlife depression, follow-up periods, and the depression–dementia association found no passage in our copy that settles the claim. (LLM, conf=0.72)
- Supportedcites [20] source
The Results report no significant association for depressive symptoms measured in 1985 (mean follow-up, 27 years), compared with an increased dementia risk for symptoms measured in 2003 (mean follow-up, 11 years). The Discussion also says that studies of earlier-life depression have found no association, although it characterizes the wider evidence as inconclusive. (LLM, conf=0.88)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Could not verify
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Serum anticholinergic activity measured by a receptor bioassay does not correlate well with effects on cognition,16 28”
§ Anticholinergic drugs and risk of dementia: case-control study > Methods > Anticholinergic drugs exposure
What the sources say
- Not checked — no full text of the sourcecites [16] source
- Supportedcites [28] source
The Introduction identifies serum anticholinergic activity (SAA) as a radioreceptor-assay measurement. The Discussion section, “SAA and cognitive outcomes” (page unavailable), says findings suggest a poor correlation between peripheral SAA levels and cognitive effects. The review also reports associations in some observational studies, so its conclusion is about the measure’s inconsistent relationship with cognition, not an absence of any association. (LLM, conf=0.91)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Anticholinergic urological drugs, particularly oxybutynin, have been consistently associated with short term cognitive decline in randomised controlled trials,8 41 so a long term risk of dementia is plausible.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
What the sources say
- Not checked — no full text of the sourcecites [8] Tannenbaum, 2012, A systematic review of amnestic and non-amnestic mild cognitive impairment induced by anticholinergic, antihistamine, GABAergic and opioid drugs, Drugs Aging source
- Partly supportedcites [41] sourceExperimental — accuracy not yet measured
The section on double-blind clinical studies reports that oxybutynin was consistently associated with cognitive deterioration in four randomised studies. The Summary and conclusions distinguishes it from other overactive-bladder antimuscarinics: darifenacin and tolterodine did not show cognitive decline in the studies reviewed. The evidence therefore supports the claim for oxybutynin, but not its broad wording about anticholinergic urological drugs as a group. The sentence presents long-term dementia risk as the citing authors’ inference, not as a finding attributed to this source. (LLM, conf=0.86)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Adjusting for time varying confounders is difficult in a matched case-control study.31 46”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Considerations for future research
What the sources say
- Partly supportedcites [31] sourceExperimental — accuracy not yet measured
The Incident user design section says case-control studies are prone to errors in confounder adjustment. It does not specify matched case-control studies or say that adjusting for time-varying confounders is difficult in that design. The Sources of exposure variation section discusses confounding as health status changes over time, but in a case-crossover design. (LLM, conf=0.84)
- Partly supportedcites [46] sourceExperimental — accuracy not yet measured
The paper’s introductory discussion says that a simple unmatched case-control estimator does not adjust for covariates and that controlling confounding is a strong concern. It also discusses matched case-control studies, but does not say that adjusting for time-varying confounders in those studies is difficult. The general concern is supported; the specific claim is not. (LLM, conf=0.77)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Over the past decade, prolonged exposure to anticholinergic drugs has been linked to long term cognitive decline or dementia incidence among community living cohorts and nursing home residents.12 13 14 15 16 17”
§ Anticholinergic drugs and risk of dementia: case-control study > Introduction
What the sources say
- Partly supportedcites [12] sourceExperimental — accuracy not yet measured
The Discussion (page not available) links higher cumulative anticholinergic use to increased dementia risk, and describes the study as a large community-based sample. The Methods (page not available) identify participants as older health-plan members; this source does not establish the claimed association among nursing home residents. (LLM, conf=0.86)
- Partly supportedcites [13] sourceExperimental — accuracy not yet measured
The Discussion reports increased risks of cognitive decline and dementia among community-dwelling elderly people taking anticholinergic drugs, and the Dementia section links chronic use to incident dementia at four-year follow-up. The cited study does not report findings for nursing home residents, so it supports only the community-living part of the sentence. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [14] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Depression has consistently been shown to be linked to increased dementia incidence in the short to medium term (up to 10 years).”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
What the sources say
- Could not verifycites [1] sourceExperimental — accuracy not yet measured
No passage from the paper’s body was retrieved addressing whether depression is consistently linked to increased dementia incidence over periods of up to 10 years. Searches for depression, dementia risk, follow-up, and the 10-year timeframe did not locate evidence for that specific claim. (LLM, conf=0.66)
- Supportedcites [20] source
The Discussion reports that depressive symptoms were associated with higher dementia risk only when measured in the decade preceding diagnosis, and notes that meta-analyses found a similar association in late life. The paper cautions that this link may reflect symptoms preceding dementia rather than depression causing it; the claim describes an association, not a cause. (LLM, conf=0.91)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Could not verify
Every source the paper cites for this claim was checked and supports it.
In the paper
“With respect to study design, our estimates generalise to those surviving at least four years after their initial anticholinergic exposure, and the nested case control design provides unbiased estimates of effects when compared with the equivalent cohort study.35”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Strengths and weaknesses of the study
What the sources say
- Supportedcites [35] source
In “Nested case-control studies: A brief overview” (page unavailable), the paper says that, as with the full cohort, conditional logistic analysis of sampled risk sets validly estimates the rate ratio. Its empirical evaluation also finds that the true rate ratio is well estimated under the standard simple-random-sampling design. The claim is supported for that standard design and analysis. (LLM, conf=0.91)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
- Probably not a substantial claim. 20
- It may state two separate claims as one. 39
- The quote only partly states this claim. 1
None of the sources cited for this claim have been checked yet.
In the paper
“Middle aged and older populations are increasingly taking multiple drugs,6 7 but the potential adverse events of long term use are not well understood.”
§ Anticholinergic drugs and risk of dementia: case-control study > Introduction
What the sources say
- Could not verifycites [6] sourceExperimental — accuracy not yet measured
The supplied Results and Discussion passages concern health conditions and functional deficits among people entering care homes, not medication use. Searches for increasing use of multiple drugs and polypharmacy returned the same unrelated passages, so our copy does not verify the claim attributed to this source. The statement about adverse events follows the citations and is not the part judged here. (LLM, conf=0.76)
- Not checked yetcites [7] Prescribing and Medicines Team. NHS Digital. Prescriptions Dispensed in the Community, Statistics for England - 2005-2016. NHS Digital 2017. http://digital.nhs.uk/catalogue/PUB20664
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Could not verify
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Lower urinary tract symptoms themselves have been linked to future dementia incidence and may be a symptom of early neurodegeneration.42 43”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
What the sources say
- Supportedcites [42] source
The Discussion reports that LUTS were associated with a higher subsequent risk of dementia in the cohort after adjustment for multiple comorbidities. It also says LUTS might be a prodrome of cognitive deficiency and an early clinical symptom of brain changes, supporting the claim’s hedged interpretation. (LLM, conf=0.90)
- Not checked — no full text of the sourcecites [43] source
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Many studies have linked anticholinergic drug use with concurrent or short term cognitive effects, but few have examined associations of long term anticholinergic exposure;8 the latter tend to report positive associations.12 14 15”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Strengths and weaknesses in relation to other studies
What the sources say
- Not checked — no full text of the sourcecites [8] Tannenbaum, 2012, A systematic review of amnestic and non-amnestic mild cognitive impairment induced by anticholinergic, antihistamine, GABAergic and opioid drugs, Drugs Aging source
- Supportedcites [12] source
The Introduction describes acute cognitive effects demonstrated in single-dose experiments and cohort studies. It also says that earlier observational studies lacked information on the dose and duration of anticholinergic use and had short follow-up periods, supporting the claim that few had examined long-term exposure. The separate claim that longer-term studies tended to find positive associations is attached to other citations in the citing sentence. (LLM, conf=0.90)
- Not matchedcites 14 15
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“A typical patient aged 65-70 might normally expect a period incidence of dementia of around 10% over the next 15 years,36 so this odds ratio would be consistent with an absolute risk increase of 2% (1% to 3%) over that period, corresponding to a number needed to harm of 50 (33 to 100).”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
What the sources say
- Supportedcites [36] source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Most recently, a cross sectional analysis of Alzheimer’s Disease Neuroimaging Initiative (ADNI) and Indiana Memory and Ageing Study (IMAS) data linked anticholinergic drug use to reduced glucose metabolism and increased brain atrophy, and to future mild cognitive impairment or Alzheimer’s disease incidence among cognitively normal participants (hazard ratio 2.47, P=0.01).39”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
What the sources say
- Partly supportedcites [39] sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In particular, late life depression is thought to be an early symptom of dementia,18 19 whereas studies of whether midlife depression is a risk factor for later life dementia have had mixed findings.20 21”
§ Anticholinergic drugs and risk of dementia: case-control study > Introduction
What the sources say
- Partly supportedcites [18] sourceExperimental — accuracy not yet measured
The Discussion says depressive symptoms in older adults may be a reaction to early cognitive decline or a sign of an underlying neurodegenerative process, supporting the late-life part of the sentence as a possibility. The paper studies older adults and does not report mixed findings about midlife depression as a risk factor for later-life dementia (searched: midlife; mixed findings). (LLM, conf=0.84)
- Not checked — no full text of the sourcecites [19] source
- Supportedcites [20] source
This source is cited for the midlife-depression clause, not the preceding late-life clause. The Discussion says evidence on depression before age 60 is inconclusive: some studies found no association with dementia, while studies that did find one had limitations. (LLM, conf=0.93)
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Anticholinergic antidepressants were linked to dementia incidence, consistent with our results, however, the authors did not test specific classes of the remaining anticholinergics.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Strengths and weaknesses in relation to other studies
What the sources say
- Supportedcites [12] source
The Results report elevated dementia risk among heavy users of anticholinergic antidepressants. The Methods say the sensitivity analysis separated antidepressants from all other anticholinergic classes, which were analyzed together rather than as individual classes. Page numbers are unavailable in our copy. (LLM, conf=0.91)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most patients (89% of cases and 87% of controls) received at least one prescription for a drug with an ACB score of 1 during the DEP, with cardiovascular drugs accounting for 63% of these prescriptions.”
§ Anticholinergic drugs and risk of dementia: case-control study > Results > Frequency of anticholinergic drugs use
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- The authors state this as an assumption: Thiazide diuretics, loop diuretics, and antihistamines have an ACB score of 1.
- The authors state this as an assumption: Diagnosed health conditions or other drugs are absent if there is no mention in the primary care record.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, when analysed by the drug class, the findings were very similar with the antidepressant, antiparkinson, and urological drugs with an ADS score of 3 and antidepressants with an ADS score of 1 consistently associated with greater dementia incidence (data not shown), but no association with other ADS classes.”
§ Anticholinergic drugs and risk of dementia: case-control study > Results > Sensitivity analyses
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A small association between antihistamine use and dementia was observed that did not meet our threshold for statistical significance.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was a dose-response effect linking average anticholinergic load, measured by the average ACB score over the DEP, with dementia incidence, although this is only evident for those with an average score of 3 or more (table 2).”
§ Anticholinergic drugs and risk of dementia: case-control study > Results > Primary analysis
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: Thiazide diuretics, loop diuretics, and antihistamines have an ACB score of 1.
- The authors state this as an assumption: Tricyclic antidepressants have an ACB score of 3.
- The authors state this as an assumption: Creams, eye drops, and ear drops have an ACB score of 0.
- The authors state this as an assumption: Diagnosed health conditions or other drugs are absent if there is no mention in the primary care record.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“but there is some evidence for an association between dementia incidence and prescription of antiparkinson drugs.”
§ Anticholinergic drugs and risk of dementia: case-control study > Results > Exposure by drug class
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe quote only partly states this claim.
- The authors state this as an assumption: Diagnosed health conditions or other drugs are absent if there is no mention in the primary care record.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The associations are attenuated from the crude rates when adjusting for drug use at the start of the DEP, and are further reduced only slightly when adjusting for covariates at the end of the DEP.”
§ Anticholinergic drugs and risk of dementia: case-control study > Results > Primary analysis
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: Thiazide diuretics, loop diuretics, and antihistamines have an ACB score of 1.
- The authors state this as an assumption: Tricyclic antidepressants have an ACB score of 3.
- The authors state this as an assumption: Diagnosed health conditions or other drugs are absent if there is no mention in the primary care record.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We found positive associations for antidepressant drugs with an ACB score of 1 with an increased risk of dementia, but not with any other drugs with an ACB score of 1.”
§ Anticholinergic drugs and risk of dementia: case-control study > Results > Exposure by drug class
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: Thiazide diuretics, loop diuretics, and antihistamines have an ACB score of 1.
- The authors state this as an assumption: Diagnosed health conditions or other drugs are absent if there is no mention in the primary care record.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In particular, antidepressants and urologicals with an ACB score of 3 and antidepressants with an ACB score of 1 remained noticeably associated with dementia.”
§ Anticholinergic drugs and risk of dementia: case-control study > Results > Sensitivity analyses
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were relatively high proportions of missing data for the body mass index, smoking, and alcohol variables.”
§ Anticholinergic drugs and risk of dementia: case-control study > Results > Missing data
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Only 1429 (3.5%) cases and 7909 (2.8%) controls were prescribed drugs with an ACB score of 2, with carbamazepine accounting for 87% of these prescriptions.”
§ Anticholinergic drugs and risk of dementia: case-control study > Results > Frequency of anticholinergic drugs use
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- The authors state this as an assumption: Diagnosed health conditions or other drugs are absent if there is no mention in the primary care record.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Prescriptions for drugs with an ACB score of 2 were relatively rare, and so results are imprecise in this group”
§ Anticholinergic drugs and risk of dementia: case-control study > Results > Exposure by drug class
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: Diagnosed health conditions or other drugs are absent if there is no mention in the primary care record.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We find a slight negative association between gastrointenstinal drugs with an ACB score of 1 and 3 and dementia with an apparent dose-response effect, although there is no mechanistic explanation for this.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These associations are consistent with the findings in table 3, except that a tentative effect of antihistamines with an ACB score of 3 is seen for patients with more than 365 DDDs prescribed during the DEP.”
§ Anticholinergic drugs and risk of dementia: case-control study > Results > Exposure by drug class
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: Tricyclic antidepressants have an ACB score of 3.
- The authors state this as an assumption: Diagnosed health conditions or other drugs are absent if there is no mention in the primary care record.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In each case (antidepressants, antiparkinsons, and urologicals with an ACB score of 3) a dose-response effect is seen with a smaller, but noticeable, positive association between dementia and recorded use of less than 90 DDDs (see supplementary materials, table 2).”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Antidepressant, urological, and antiparkinson drugs with definite anticholinergic activity are linked to future dementia incidence, with associations persisting up to 20 years after exposure”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Conclusion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Use of gastrointestinal drugs with an ACB score of 1 or 3, and cardiovascular drugs with an ACB score of 1 was associated with a minor reduction in the risk of dementia.”
§ Anticholinergic drugs and risk of dementia: case-control study > Results > Exposure by drug class
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: Thiazide diuretics, loop diuretics, and antihistamines have an ACB score of 1.
- The authors state this as an assumption: Tricyclic antidepressants have an ACB score of 3.
- The authors state this as an assumption: Diagnosed health conditions or other drugs are absent if there is no mention in the primary care record.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Table 1 shows that diagnoses of conditions related to dementia and indications for anticholinergics increased during the DEP.”
§ Anticholinergic drugs and risk of dementia: case-control study > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: Diagnosed health conditions or other drugs are absent if there is no mention in the primary care record.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Although we carefully adjusted for depression diagnosis, severity, symptoms, and duration (see supplementary materials, appendix 4), residual confounding cannot be excluded.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Evidence from anticholinergic cessation trials have not shown improvements in cognitive function, but these have been underpowered and focused on short term outcomes.40”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
What the sources say
- Not checked — no full text of the sourcecites [40] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study uses a longer patient history in a larger sample of patients.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Strengths and weaknesses in relation to other studies
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Dementia codes were derived by comparing a previous published list with the Department of Health’s Quality and Outcomes Framework list of business codes for dementia.23 24 These two code lists overlapped almost completely. The combined list was reviewed by our clinical team, and all codes were included in our final definition—except those that related explicitly to alcohol related dementia”
§ Anticholinergic drugs and risk of dementia: case-control study > Methods > Selection of cases and controls
What the sources say
- Not checked — no full text of the sourcecites [23] source
- Not checked yetcites [24] Health and Social Care Information Centre. NHS Outcomes Framework. 2013. http://www.hscic.gov.uk/catalogue/PUB13054 (accessed 24 Jun 2014).
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although set in the UK, our findings are likely generalisable to other developed countries.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Strengths and weaknesses in relation to other studies
Strength:hedged· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“P<0.01 was prespecified as a threshold for statistical significance owing to the large number of subgroups being examined.”
§ Anticholinergic drugs and risk of dementia: case-control study > Methods > Statistical analysis
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“the anticholinergic effects of drugs are usually classified using scales developed by expert consensus aided by a literature review.29”
§ Anticholinergic drugs and risk of dementia: case-control study > Methods > Anticholinergic drugs exposure
What the sources say
- Not checked — no full text of the sourcecites [29] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our primary analysis measured confounders recorded up to the end of the DEP to best capture the indications of the drugs. We also coded the status of each patient with respect to each covariate up to the start of the DEP, as some variables could be consequences of drug exposure.”
§ Anticholinergic drugs and risk of dementia: case-control study > Methods > Covariates
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
In the paper
“It is difficult to accurately assess the anticholinergic activity of each drug, and anticholinergic scales differ with respect to how they classify drugs.29”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Strengths and weaknesses of the study
What the sources say
- Not checked — no full text of the sourcecites [29] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, these studies have been limited in their ability to determine if the increased risk is specific to the anticholinergic action itself, and whether or not the association is owing to the drugs or the underlying conditions for which they were prescribed.”
§ Anticholinergic drugs and risk of dementia: case-control study > Introduction
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Sample size was determined by the maximum available data within CPRD.”
§ Anticholinergic drugs and risk of dementia: case-control study > Methods > Statistical analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Use of anticholinergic drugs among people with dementia is recognised as inappropriate by both the Beers and the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria.10 11”
§ Anticholinergic drugs and risk of dementia: case-control study > Introduction
What the sources say
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Other antidepressants (predominantly selective serotonin reuptake inhibitors) with an ACB score of 1 were associated with dementia, but that association was greater for prescriptions close to dementia incidence, suggesting that reverse causation could be a possible explanation for this observed association.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This misclassification would shrink estimated effects towards the null (odds ratio of 1) but would not remove them completely.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Strengths and weaknesses of the study
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Mechanistic evidence for a link between anticholinergic drugs and dementia incidence is limited, but neuropathological studies in humans and mice do support a role of anticholinergics affecting neurodegenerative pathology.37 38”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
What the sources say
Strength:plain· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This enables a much more granular disaggregation of the effects of specific drug classes in different periods before diagnosis, and in the depth of confounding control possible using complete primary care records, which enables exploration of alternative explanations for observed associations.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Strengths and weaknesses in relation to other studies
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Together these aspects substantially narrow the target of potential harm.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Strengths and weaknesses in relation to other studies
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These relations were seen even for exposures 15-20 years before the diagnosis of dementia, suggesting that reverse causation or confounding with early dementia symptoms are less likely explanations for the effect.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Secondly, to be certain that potential confounders preceded drug initiation and not vice versa, we further excluded patients who were prevalent users at the start of each DEP, again with little difference in results.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Considerations for future research
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“It is well known that anticholinergics affect cognition,8 and guidelines suggest they are to be avoided among frail older people.9”
§ Anticholinergic drugs and risk of dementia: case-control study > Introduction
What the sources say
- Not checked — no full text of the sourcecites [8] Tannenbaum, 2012, A systematic review of amnestic and non-amnestic mild cognitive impairment induced by anticholinergic, antihistamine, GABAergic and opioid drugs, Drugs Aging source
- Not checked yetcites [9] National Institute for Health and Care Excellence. Urinary incontinence in women: management. NICE guideline CG171. 2015.https://www.nice.org.uk/guidance/cg171?unlid= (accessed 10 Feb 2017).
Strength:boosted· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The associations reported here are moderate (odds ratios for different exposures between 1.1 and 1.3), but given the high incidence of dementia they reflect an appreciable risk to patients.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Seven controls were used to maximise the power to detect associations with potentially rare exposures or covariates, and to adhere to the limits of the data provider regarding the maximum sample size for a single study.”
§ Anticholinergic drugs and risk of dementia: case-control study > Methods > Selection of cases and controls
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although very few patients (around 0.3% of the sample) are prescribed more than 365 DDDs of antihistamines in our study, those with fewer prescriptions may also have a substantial over-the-counter use that is not recorded.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Implications for clinicians and policymakers
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Drugs obtained over-the-counter are not recorded in our data, hence we will have likely underestimated the use of certain antihistamines.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Strengths and weaknesses of the study
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study used a large, population representative, primary care database that allowed a detailed analysis of the association between dementia incidence and prescriptions of different drugs classes up to 20 years before a diagnosis of dementia.”
§ Anticholinergic drugs and risk of dementia: case-control study > Discussion > Strengths and weaknesses of the study
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The authors state this as an assumption.
Thiazide diuretics, loop diuretics, and antihistamines have an ACB score of 1.
“thiazide diuretics, loop diuretics, and antihistamines have an ACB score of 1”
The authors state this as an assumption.
Tricyclic antidepressants have an ACB score of 3.
“tricyclic antidepressants have an ACB score of 3”
The authors state this as an assumption.
Creams, eye drops, and ear drops have an ACB score of 0.
“creams, eye drops, and ear drops have an ACB score of 0”
The authors state this as an assumption.
Diagnosed health conditions or other drugs are absent if there is no mention in the primary care record.
“diagnosed health conditions or other drugs are assumed absent if there is no mention in the primary care record.”
The paper relies on this without support.
It is not known if the reported associations between the use of anticholinergic drugs and future cognitive decline and dementia incidence can be attributed to anticholinergic activity.
“It is not known if the reported associations between the use of anticholinergic drugs and future cognitive decline and dementia incidence can be attributed to anticholinergic activity”
The paper relies on this without support.
This is the first study to individually estimate the effect of classes of anticholinergic drugs with respect to dementia incidence.
“This is the first study to individually estimate the effect of classes of anticholinergic drugs with respect to dementia incidence.”
The paper relies on this without support.
In the UK, most diagnoses of dementia are made by memory services specialists and communicated back to primary care.
“In the UK, most diagnoses of dementia are made by memory services specialists. The diagnoses are then communicated back to primary care.”
The paper relies on this without support.
Use of drugs with anticholinergic activity is associated with impaired cognition in the short term.
“Use of drugs with anticholinergic activity is associated with impaired cognition in the short term”
The paper relies on this without support.
Primary care records include detailed records of diagnoses and symptoms that have allowed good confounding control.
“Primary care records do not hold detailed lifestyle or demographic information, but do include detailed records of diagnoses and symptoms that have allowed good confounding control.”
The paper relies on this without support.
Defined daily doses represent the best available method for comparing the levels of exposure of different drug classes.
“Defined daily doses (DDDs) can be difficult to establish for certain drugs yet represent the best available method for comparing the levels of exposure of different drug classes.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Despite these differences, Richardson et al12 also found increases in dementia risk for the groups of antidepressant, urological, and antiparkinson drugs considered and no associations for gastrointestinal or antihistamine drugs.”
From Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study (2019) · cites this paper as [12]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“A study by Richardson et al,12 using another United Kingdom primary care database (CPRD), reported findings similar to ours, despite some differences in the drugs included, exposure measures used, exposure windows, and the confounding variables accounted for.”
From Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study (2019) · cites this paper as [12]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Anticholinergic drugs block acetylcholine, a neurotransmitter essential for cognitive function, and have been associated with an increased risk of dementia in older adults [15, 31, 32].”
From Long-Term Antidepressant Use and Dementia Risk: A Propensity Score-Matched Study of Swiss Older Adults, with an Anticholinergic-Specific Analysis (2026) · cites this paper as [32]
The cited source says what the claim attributes to it.
In the citing paper
“Anticholinergic drugs block acetylcholine, a neurotransmitter essential for cognitive function, and have been associated with an increased risk of dementia in older adults [15, 31, 32].”
From Long-Term Antidepressant Use and Dementia Risk: A Propensity Score-Matched Study of Swiss Older Adults, with an Anticholinergic-Specific Analysis (2026) · cites this paper as [32]
The cited source says what the claim attributes to it.
In the citing paper
“This association between anticholinergic antidepressants and dementia aligns with previous longitudinal cohort studies indicating that anticholinergic medications negatively affect cognitive performance [15, 31, 32, 43, 44].”
From Long-Term Antidepressant Use and Dementia Risk: A Propensity Score-Matched Study of Swiss Older Adults, with an Anticholinergic-Specific Analysis (2026) · cites this paper as [32]
The cited source says what the claim attributes to it.
In the citing paper
“Studies have demonstrated that cumulative exposure to anticholinergic antidepressants is significantly associated with a higher dementia risk, with effects persisting up to 20 years post-exposure [32].”
From Long-Term Antidepressant Use and Dementia Risk: A Propensity Score-Matched Study of Swiss Older Adults, with an Anticholinergic-Specific Analysis (2026) · cites this paper as [32]
The cited source says what the claim attributes to it.
In the citing paper
“A recent larger study12 found varying risks associated with different types of anticholinergic drugs and concluded that further research should examine individual anticholinergic drug classes.”
From Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study (2019) · cites this paper as [12]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
ACB score 2 association increased, rather than decreased, in the new-user analysis
MinorThe text says the new-user restriction produced small reductions for both ACB scores 3 and 2. For ACB score 2, however, the end-of-period adjusted odds ratio rose from 1.10 in the primary analysis to 1.12.
“This led to small reductions in the association between dementia incidence and any drug with an ACB score of 3 (odds ratio 1.07, 95% confidence interval 1.04 to 1.10) and any drug with an ACB score of 2 (1.12, 1.04 to 1.21)”
“| 2 | 1429 (3.5) | 7909 (2.8) | | 1.27§ (1.20 to 1.35) | 1.10§ (1.03 to 1.17) | 1.10§ (1.03 to 1.16) |”
Highest average ACB category has conflicting boundaries
MinorThe methods say the highest category includes scores of 5 or more, but Table 2 labels it greater than 5.0. Under the table's stated boundaries, an average score of exactly 5.0 falls into neither of its two highest categories.
“but with two additional groups representing those with particularly high (3-5 and 5 or more) average ACB scores.”
“| >5.0 | 1570 (3.9) | 8132 (2.9) | | 1.53§ (1.44 to 1.62) | 1.31§ (1.23 to 1.40) | 1.28§ (1.19 to 1.36) |”
Citations
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Self-citationEvaluating medication effects outside of clinical trials: new-user designs
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Self-citationCumulative Use of Strong Anticholinergics and Incident Dementia: A Prospective Cohort Study
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Age, Neuropathology, and Dementia
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Allison, S. J., & Gibson, W. (2018) · Therapeutic Advances in Urology · doi:10.1177/1756287218801282 · Cited by 29
Medication transitions: Vulnerable periods of change in need of human factors and ergonomics
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Receipt of Overactive Bladder Drugs and Incident Dementia: A Population-based Case-control Study
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Metadata
- Authors
- Richardson, K., Fox, C., Maidment, I., Steel, N., Loke, Y. K., Arthur, A., Myint, P. K., Grossi, C. M., Mattishent, K., Bennett, K., Campbell, N. L., Boustani, M., Robinson, L., Brayne, C., Matthews, F. E., & Savva, G. M.
- Affiliations
- University of East Anglia (GB)
- Aston University (GB)
- University of Aberdeen (GB)
- Royal College of Surgeons in Ireland (IE)
- Purdue University West Lafayette (US)
- Indiana University Indianapolis (US)
- Newcastle University (GB)
- University of Cambridge (GB)
- Corresponding author
- Richardson, Kathryn
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2018-04-25
- Volume
- 361
- Pages
- k1315
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- PMC
- PMC5915701
- OpenAlex
- W2800521692
- Cited by
- 520
- References
- 44
- Citations by year
- 2026: 36 · 2025: 48 · 2024: 56 · 2023: 49 · 2022: 45 · 2021: 71 · 2020: 127 · 2019: 61 · 2018: 25
- FWCI
- 54.35
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-10-31)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Aston Publications Explorer (Aston University) (acceptedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by-nc)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- Repository@Hull (Worktribe) (University of Hull) (submittedVersion, cc-by)
- HighWire Press Open Archive (submittedVersion)
- Apollo
- Funders
- Alzheimer's Society (AS-PG-2013-017)
- National Institute for Health and Care Research (NF-SI-0616-10090, NF-SI-0611-10084, ACF-2014-15-001)
- Aston University
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Pharmacology (medical) › Cholinesterase and Neurodegenerative Diseases
- Keywords
- anticholinergic agents, dementia, Anticholinergic Cognitive Burden Scale, antidepressants, antiparkinsonian drugs, urological drugs, gastrointestinal drugs, drug exposure duration, older adults, incident dementia risk
- MeSH terms
- Aged, Aged, 80 and over, Antidepressive Agents, Tricyclic, Dementia, Female, United Kingdom, Health Services Research, Humans, Male, Odds Ratio, Case-Control Studies, Risk Assessment, Cholinergic Antagonists
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-11-07, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-11-07 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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