a wonderfully atmospheric phrase played by the cellos and basses. ȈȈǸǸȈȈǹǹȆȆǹǹȅȅǻǻȂȂǼǼȂȂǽǽȃȃǾǾȁȁǾǾȁȁǾǾȁȁǿǿȀȀǾǾȀȀǿǿȀȀǿǿȀȀǿǿȀȀǾǾȁȁǹǹȉȉǹǹȊȊǸǸȋȋǹǹȍȍǸǸȋȋǺǺȈȈǼǼȃȃǽǽȁȁǽǽȂȂǽǽȂȂǾǾȂȂǽǽȂȂǺǺȌȌǹǹȍȍǻǻȇȇǼǼȇȇǼǼȅȅǼǼȆȆǹǹȍȍǸǸȓȓǵǵȘȘdzdzȒȒǴǴȖȖDzDzȕȕǹǹȔȔǸǸȈȈǽǽȂȂǽǽȂȂǽǽȁȁǽǽȃȃǾǾȂȂǾǾȁȁǿǿȁȁǿǿȀȀǿǿȀȀǸǸȅȅǰǰȗȗǮǮțțǫǫȜȜǪǪșșdzdzȖȖǺǺȌȌǻǻȇȇǻǻȈȈǼǼȆȆǼǼȉȉǹǹȍȍǸǸȑȑǴǴȑȑǶǶȑȑǸǸȏȏǻǻȇȇǻǻȅȅǽǽȄȄǽǽȂȂǽǽȃȃǹǹȋȋǷǷȓȓǶǶȒȒǶǶȑȑǴǴȏȏǵǵȏȏǶǶȐȐǸǸȐȐǵǵȐȐǴǴȏȏǷǷȎȎǸǸȍȍǸǸȍȍǸǸȎȎǸǸȍȍǶǶȐȐǵǵȓȓDZDZșșǭǭȝȝǬǬȗȗdzdzȕȕǴǴȐȐǹǹȋȋǺǺȇȇǼǼȄȄǾǾȃȃǾǾȁȁǽǽȂȂǸǸȅȅǹǹȆȆǺǺȈȈǺǺȆȆǻǻȅȅǼǼȅȅǾǾȂȂǾǾȂȂǺǺȈȈǸǸȊȊǷǷȉȉǺǺȆȆǻǻȄȄǻǻȄȄǻǻȄȄǻǻȃȃǻǻȃȃǻǻȃȃǼǼȃȃǼǼȃȃǽǽȂȂǼǼȂȂǾǾȁȁǾǾȁȁǾǾȁȁǾǾȁȁǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǿǿȀȀǾǾȂȂDzDzȕȕǪǪțțǪǪȟȟǪǪȗȗǵǵȆȆǽǽȂȂǽǽȄȄǼǼȉȉǹǹȌȌǷǷȋȋǹǹȉȉǺǺȄȄǽǽȂȂǼǼȄȄǽǽȂȂǽǽȂȂǻǻȄȄǾǾȄȄǵǵșșǥǥȠȠǡǡȥȥǠǠȣȣǮǮȚȚǬǬțțǸǸȋȋǺǺȅȅǻǻȂȂǻǻȃȃǼǼȃȃǽǽȂȂǻǻȃȃǸǸȅȅǾǾȂȂǽǽȆȆǶǶȒȒdzdzȕȕǷǷȔȔǷǷȏȏǸǸȊȊǸǸȌȌǸǸȍȍǸǸȍȍǷǷȎȎǸǸȏȏǷǷȐȐǷǷȑȑdzdzȕȕDZDZȓȓdzdzȐȐDzDzȖȖǸǸȈȈǾǾȃȃǾǾȁȁǽǽȁȁǾǾȂȂǽǽȄȄǽǽȉȉǹǹȍȍǸǸȏȏǹǹȐȐǷǷȒȒǷǷȒȒǵǵȓȓǵǵȓȓǴǴȘȘdzdzȖȖǵǵȔȔǼǼȌȌǺǺȈȈǸǸȅȅǻ

ǾǾȂȂǻǻȅȅǷǷȏȏDzDzȖȖDzDzșșDZDZșșǼǼȉȉǼǼȆȆǼǼȃȃǻǻȄȄǸǸȊȊdzdzȋȋǴǴȍȍǴǴȋȋǹǹȇȇǷǷȒȒǵǵȓȓǵǵȔȔǵǵȔȔǷǷȎȎǷǷȉȉǵǵȉȉǰǰȑȑǮǮȖȖǮǮȕȕDZDZȒȒǮǮȓȓǰǰȖȖǯǯȑȑǦǦȘȘǪǪȘȘǣǣȝȝǨǨȝȝǮǮȖȖǶǶȊȊǽǽȃȃǽǽȁȁǽǽȁȁǾǾȁȁǾǾȁȁǻǻȆȆǯǯȞȞǡǡȳȳǢǢȰȰǡǡȳȳǧǧȫȫdzdzȢȢǶǶȞȞdzdzțțǶǶȘȘǷǷȋȋǷǷȒȒǸǸȏȏǶǶȑȑǵǵȒȒǶǶȑȑǵǵȔȔǵǵȔȔǵǵȕȕǷǷȔȔǷǷȖȖǷǷȒȒǶǶȑȑǴǴȒȒǶǶȔȔǶǶȑȑǵǵȎȎǷǷȍȍǺǺȅȅǺǺȆȆǷǷȈȈdzdzȋȋǴǴȏȏǴǴȋȋǸǸȉȉǶǶȈȈǵǵȍȍǶǶȌȌǵǵȉȉǺǺȅȅǵǵȑȑǫǫȞȞǯǯȞȞǪǪȝȝǥǥȢȢǨǨȣȣǩǩȞȞǮǮșșǰǰȗȗdzdzȔȔǴǴȑȑǹǹȋȋǹǹȇȇǽǽȃ

Claim1: Drugs used by millions to treat Parkinson’s, depression, and bladder problems may raise the risk of dementia

Chiang C-H, Wu M-P, Ho C-H, et al. Lower Urinary Tract Symptoms Are Associated with Increased Risk of Dementia among the Elderly: A Nationwide Study. Biomed Res Int 2015;2015:1. doi:10.1155/2015/187819.

Yoshiyama Y, Kojima A, Itoh K, et al. Does Anticholinergic Activity Affect Neuropathology? Implication of Neuroinflammation in Alzheimer’s Disease. Neurodegener Dis 2015;15:140-8. doi:10.1159/000381484.

45Ehrt U, Broich K, Larsen JP, Ballard C, Aarsland D. Use of drugs with anticholinergic effect and impact on cognition in Parkinson’s disease: a cohort study. J Neurol Neurosurg Psychiatry 2010;81:160-5. doi:10.1136/jnnp.2009.186239.

A robust association between some classes of anticholinergic drugs and future dementia incidence was observed.

Limited human data support the conclusion that anticholinergic activity enhances AD-related neuropathology and neurodegeneration. However, experimental data from a tauopathy mouse model indicated anticholinergic activity might enhance neurodegeneration with enhanced neuroinflammation including microglial activation.

Clinically, anticholinergic activity causes a decline in cognitive function and increases the risk of dementia, thus possibly enhancing AD pathologies and neurodegeneration. Until now there has been insufficient human neuropathological data to support this conclusion.

Though the 30% increased risk of developing dementia from long-term anticholinergic use is significant, it is still less than the risk associated with other modifiable risk factors for dementia such as smoking, social isolation and physical inactivity. These lifestyle factors are associated with a 40% to 60% increased risk of developing dementia, according to a 2017 study.

"Previous studies had really only said that anticholinergics were associated with dementia incidence," said George Savva, researcher of health sciences at the University of East Anglia and a lead author on the study, in a news briefing. "But we broke it down by class, which is where our study really has its novelty and power."

The new study, published Wednesday in the British Medical Journal, looked at the risk of new-onset dementia among nearly 350,000 older adults in the United Kingdom. The researchers found that people who used certain types of anticholinergics, such as those used to treat depression, Parkinson's and urinary incontinence, for a year or more had about a 30% increased risk of developing dementia down the road.

Anticholinergic drugs function by blocking the effects of acetylcholine, a chemical released by nerve cells to send signals to other nerves and muscles. They are prescribed to 20% to 50% of older adults in the United States to treat a variety of neurological, psychiatric, gastrointestinal, respiratory and muscular conditions, according to a 2009 study. In the UK, 34% to 48% of older adults take them, another study found.

The cognitive side effects of medications with anticholinergic activity have been documented among older adults in a variety of clinical settings. However, there has been no systematic confirmation that acute or chronic prescribing of such medications lead to transient or permanent adverse cognitive outcomes.

“We found that people who had been diagnosed with dementia were up to 30 per cent more likely to have been prescribed specific classes of anticholinergic medications,” said Dr George Savva from UEA’s School of Health Sciences and the lead author of the study published in the BMJ today.

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