Medication Review

Anticholinergic medications should be stopped where possible.

• Anticholinergic medications work by decreasing the amount of cholinergic neurotransmitters available - these neurotransmitters are the very thing that medications such as Donepezil, which can slow the initial progression of dementia symtoms, are trying to enhance.  
• Anticholinergics as a class of drugs can potentially contribute to a medication-induced cognitive impairment. 

Drugs with a strong anti-cholinergic burden include:

• Drugs for bladder instability: oxybutin, solifenacin, tolterodine
• Amitriptyline
• Hydroxyzine

The following medications can cause confusion and contribute to, or mimic, cognitive impairment:

1. Anticonvulsants – all anticonvulsants can potentially impair cognitive function
2. Antidepressants – risks highest in tricyclics. Withdrawal delirium also occurs
3. Antipsychotics – those with considerable anticholinergic activity may worsen delirium
4. Anti-parkinsonian drugs – risk highest in those with anticholinergic activity
5. Cardiac drugs – including digoxin and calcium antagonists
6. Corticosteroids – risk is dose related
7. Hypnotics/Sedatives – more common with long-acting benzodiazepines
8. Opioid analgesics – risk highest with pethidine