Dementia is a progressive neurological condition characterised by a decline in cognition, memory, language and social functioning. It is most common in older people, affecting almost 10% of Australians aged 65 years or above.

Learning objectives

After reading this article, pharmacists should be able to:

  • Explain the concept of anticholinergic load or burden, and its potential for harm in people with dementia
  • Identify anticholinergic medicines and other medicines with anticholinergic effects
  • Recognise possible alternatives for anticholinergic medicines.

Competencies (2016) addressed: 1.1, 1.4, 1.5, 3.1, 3.2, 3.3, 3.5.

Accreditation code: CAP1904B

Case scenario

Mrs Atkins, 78 years old, lives at home with her 80-year-old husband. She was diagnosed with Alzheimer’s disease (AD) about five years ago, and has progressed to moderate stage disease. She is dependent on her husband for most activities of daily living. Her extensive medical history includes hypertension, heart failure, hypercholesterolaemia, depression, osteoporosis, urge incontinence and constipation. Over the past few months Mrs Atkins has become increasingly agitated, has wandered outside the home twice, and has fallen repeatedly. She has been referred to you for a medication review. Her medication list is as follows:

MEDICINE DOSE INDICATION
Donepezil 10 mg at night Alzheimer’s disease
Amitriptyline 150 mg at night Major depression
Temazepam 10 mg at night Insomnia
Atorvastatin 10 mg in the morning Hypercholesterolaemia
Alendronate 70 mg on Monday mornings Osteoporosis
Oxybutynin 5 mg at night Urge incontinence
Telmisartan 80 mg in the morning Hypertension
Metoprolol 50 mg in the morning Chronic heart failure
Furosemide 20 mg in the morning when required Oedema associated with heart failure

 Test your knowledge on this article’s assessment questions here to earn up to 1.5 Group 2 CPD credits.