Anticholinergic Medications Linked to Dementia Similar to Early Alzheimer’s

High anticholinergic burden correlated with impairments in learning, memory, and visuospatial ability in older adults diagnosed with schizophrenia


A new study, published in the Journal of Clinical Psychiatry, investigates the effects of anticholinergic medications, such as antidepressants and antipsychotics, on cognition in older adults diagnosed with schizophrenia. The study was led by Tarek Rajji, an associate professor of psychiatry at the University of Toronto and the Chief of the Adult Neurodevelopment and Geriatric Psychiatry Division at the Centre for Addiction and Mental Health. Rajji and colleagues find that use of anticholinergic drugs can lead to cognitive impairment similar to what is seen in early Alzheimer’s dementia.

“We need to be mindful of the anticholinergic properties of the medications we’re using and their potential negative impact on cognition. This is especially true as our patients are getting older and more susceptible to the anticholinergic properties of these medications,” stated Rajji in a Medscape press release.

Photo Credit: Neil Moralee, Flickr

In Canada, 20% of individuals diagnosed with schizophrenia will be over the age of 65 by 2025. Individuals with schizophrenia are twice as likely to develop dementia before age 80. Both environmental and physical health factors have been linked to individuals with schizophrenia developing dementia.

Anticholinergic medications include antipsychoticsantidepressants, and mood stabilizers. “There is also increasing evidence that anticholinergic medications increase the risk of Alzheimer’s dementia,” write the authors. Older adults with schizophrenia may be especially vulnerable to the negative effects of anticholinergic medications due to age-related physical changes.

The authors use the term “anticholinergic burden” to refer to “the anticholinergic load of multiple medications and their metabolites rather than just a single compound.” They distinguish between stable cognitive impairment commonly seen in individuals with schizophrenia, and “progressive cognitive impairment seen in neurodegenerative processes such as Alzheimer’s dementia” that may be accelerated by anticholinergic burden.

The researchers sought to determine the association between anticholinergic burden and cognitive functioning in adults who were 50 years or older.  Sixty individuals living in the community who were diagnosed with either schizophrenia or schizoaffective disorder were recruited for the study. Participants engaged in neuropsychological testing that assessed cognitive functioning in areas where deficits are often found in Alzheimer’s dementia (e.g., memory, visuospatial), as well as executive functioning, which is commonly impaired in individuals diagnosed with schizophrenia. The researchers assessed anticholinergic burden using the Anticholinergic Cognitive Burden (ACB) scale, which includes a list of medications that have anticholinergic effects. A score of 3 or greater on the ACB denotes “definite anticholinergic activity.”

High anticholinergic burden was associated with poorer dementia-related cognitive functioning. Individuals with an ACB score of 1.5 or greater experienced significant adverse cognitive effects. The authors summarize, “Our results suggest that high anticholinergic burden is common among patients with schizophrenia, and it may account for some of their increased risk for dementia.”

“Higher anticholinergic burden was specifically associated with poorer performance on measures of delayed memory, episodic memory, immediate memory, spatial working memory, and visuospatial-construction, but not attention, executive function, language, or reaction time,” report the researchers.

The findings bolster previous evidence that anticholinergic drugs are significantly associated with Alzheimer’s-like cognitive impairment. The researchers highlight:

“Clinicians should be aware that high anticholinergic burden in older individuals with schizophrenia may contribute to a pattern of cognitive deficits characteristic of early Alzheimer’s dementia. These deficits may be misattributed to progression of underlying disease (ie, schizophrenia) or to the onset of dementia rather than to a secondary treatable cause (ie, anticholinergic medication).”

The researchers call for stronger screening techniques that could detect reversible risk factors (e.g., anticholinergic burden) for developing dementia in older adults with schizophrenia. They therefore recommend regular medication reviews and the use of the ACB scale in clinical settings.



Tsoutsoulas, C., Mulsant, B. H., Kumar, S., Ghazala, Z., Voineskos, A. N., Menon, M., … & Rajji, T. K. (2017). Anticholinergic burden and cognition in older patients with schizophrenia. The Journal of Clinical Psychiatry. Advance online publication. doi:10.4088/JCP.17m11523 (Link)

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Shannon Peters
MIA Research News Team: Shannon Peters is a doctoral student at the University of Massachusetts Boston and has a master’s degree in mental health counseling. She is particularly interested in exploring the impacts of medicalization and pathologizing the experiences of individuals who have been affected by trauma. She is engaged in research on the effects of institutional corruption and financial conflicts of interest on research and practice.


  1. The anticholinergic drugs can actually create, not just symptoms that look like dementia, but also symptoms that look like the positive symptoms of “schizophrenia,” in people of all ages. Drugs don’t actually know how old the person taking them is.

    These are the “central symptoms” of anticholinergic intoxication syndrome, according to The central symptoms “may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

    The only difference between the central symptoms of anticholinergic toxidrome and the positive symptoms of “schizophrenia” is “hyperactivity” vs. “inactivity.” And the neuroleptics are known to make all people sleep too much, which can lead even a hyperactive person to be less active, thus can lead them to complain of inactivity, or not being as productive as usual.

    I, at the time a healthy 36 year old woman, suffered my first, anticholinergic toxidrome induced, “psychotic break,” just two weeks after being given a child’s dose of Risperdal, .5mg – supposedly to “cure” the common symptoms of antidepressant discontinuation syndrome, which were misdiagnosed as many DSM disorders by many doctors.

    Trust me, doctors absolutely can not tell the difference between “psychosis” created via anticholinergic toxidrome, and “psychosis” created via any one of the scientifically invalid DSM “disorders.”

    But since anticholinergic toxidrome is not listed in the DSM billing code “bible,” it is always misdiagnosed as one or many of the billable DSM disorders, since this is the only way the psychiatrists can get paid. And, of course, when doctors misdiagnose someone, they end up mistreating them as well, in other words, they commit lots and lots of malpractice. This would be a systemic problem for today’s psychiatric industry.

    It is my contention that “schizophrenia,” and all of the DSM disorders, are not actually real diseases. And what the psychiatrists believe is “schizophrenia,” or any of the other “psychotic disorders,” is actually either neuroleptic induced deficit syndrome, which creates symptoms that look like the negative symptoms of “schizophrenia.”

    Or it is anticholinergic toxidrome, which creates symptoms that look like the positive symptoms of “schizophrenia.”

    Thus, most “schizophrenia” is likely an illness with an iatrogenic, as opposed to “genetic,” etiology. And given that “the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012).”

    It is highly likely that most “schizophrenics” are actually child abuse victims who were misdiagnosed, silenced, and turned into the “schizophrenics” with the neuroleptic drugs, the so called “gold standard schizophrenia treatment.”

    The solution, thus, is to stop prescribing the neuroleptics/antipsychotic drugs, as opposed to changing the “schizophrenia” misdiagnoses to “dementia” misdiagnoses.

    And the truth being told, torturing child abuse victims on a massive scale is inappropriate human behavior, psychiatric industry. And your profiteering off of doing such for decades has empowered the pedophiles, so much so, that Western civilization is now ruled by “luciferian pedophiles.” Just google it. You apparently lacked foresight into the long run ramifications of your “dirty little secret of the two original educated professions.”

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    • I believe it’s approximately
      10 years because of nicotine (other substance) misuse + 10 years because of diabetes/heart disease induced by neuroleptics.

      Nash lived till 86 (and would probably even more). You can also look up Laing’s ex-patients. Pretty normal lifespan.

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  2. “This medication might make you constipated or give you a dry mouth,” said the doctor. “It’s a minor nuisance compared to the benefits you will get.”

    Liars such as this can easily be identified because they cover their genius heads with toilet plungers.

    Psychiatry needs to be flushed down the can along with their garbage science.

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    • The doctor knew nothing about anticholinergic hallucinogens, like the daturas- too powerful to be consumed internally (an unknown reality missed by hippie types) and fly amanita- if you’re dumb enough to trip on these, be smart enough to leave one uneaten cap on hand, so the ER doc has a sample when he calls poison control (before he turns you into a berserker with an antipsychotic drug injection).

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  3. I’m hoping that as health care costs go up, psychiatry will be further examined, especially in nations where the government provides much of the health care. Clearly, one reason for this study is the rising costs of care for “Schizophrenics,” in places with nationalized health care (in particular). Who knows…maybe, as the population continues aging, costs continue going up, and psychiatry is seen for the extraordinary fraud and massive waste that it is, the psychiatric establishment will shrivel, not because of determined activists or shifts in ideology, but simply because there’s no justification for such out of control costs with no benefits.

    One can dream, anyway…

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    • Because if they do, then surely everyone else should too? Including the alcohol industry, the caffeine industry, the sugar industry, the synthetic sweetener industry, all contact sports, low-oxygen environment bucket-list pursuits, the internet, numerous new age interventions, jogging in urban environments, breathing the city air, the list goes on and on.

      I’m not an advocate for brain damage, although, realistically, in a moment of absolute honesty, I must admit to being quite partial to a bit of it, from time to time. Which places me in that sweet spot often referred to as the “average human”.

      I write that not to undermine you, more to point out how desperately hopeless it can feel when trying to advocate against brain-damage in a world that by and large endorses it, albeit quietly, often unwittingly, under the surface so to speak.

      O and, Happy Christmas!

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      • For one momentary shudder of a moment I thought there was a conspiracy of inducing dementia in people and then fucking them up with drugs in order to go on to induce actual physical correlates, and that the whole brain-scan culture of fear and lies was an intentional appendage to the demonic discourse.

        It might be.

        But I think people are taking knocks to the brain throughout their lives that are not rubberstamped as such, so’s and such it all gets shrugged off and disregarded.

        Even to this wretched day people are prattling on about the disconnect between having your head repeatedly bashed in, occasionally losing consciousness, and then it all happening again, as having any plausible, sensible connection with later diminishment of mental faculties. Or personality or mood change. Unless the necrotic persona falls bankrupt. Or they are looking for some way to plead innocent.

        People talk about plasticity like it’s just been discovered. But long before that shitty word there were stories told of the man that took a knock to the head and then ended up as a fucking werewolf, or the mad old lady that lived alone and she lost it one night and ate multiple babies. Or the man that dug a large hole and then got down into the hole and told them to cover the hole and come back when all the birds had gone, and the day came the birds had gone, and they dragged the false heaven’s back and he was on his back with one foot in his mouth, chewing it, and was wide-eyed and covered in his own defecate.

        Brain damage.

        All of it. At least for this evening I will console myself with the nihilistic notion that every moment of learning from that first albuminic splice, is brain damage. It’s probably a heavy metal song. There’s probably a long, groin-slapping guitar solo in the middle section, and I’m not liking it.

        Happy Christmas.

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  4. “Anticholinergic medications include antipsychotics, antidepressants, and mood stabilizers.” Today’s DSM recommendations for “bipolar” do recommend combining these same drug classes.

    One must wonder how long it will take for the psychiatric industry to realize their DSM drug cocktail recommendations for “bipolar” are really stupid, thus need to be changed. Combining these drug classes should never be done, because this will increase the chance of an innocent patient suffering from anticholinergic intoxication syndrome. Symptoms of which, of course, the doctors can’t distinguish from the positive symptoms of “schizophrenia.”

    I agree with you, Steve, it’s time the psychiatric industry just admits they’re intentionally brain damaging innocent human beings for profit. And, according to a pediatrician I spoke with recently, the doctors can’t stop defaming and torturing the innocent little “bipolar” misdiagnosed children, because it’s just too profitable. The doctors have lost their minds.

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  5. All psychiatric drugs cause dementia. The book to read on the subject is: Drug Induced Dementia by Grace E Jackson. The only thing that I disagree with, is that it’s not a perfect crime. Because we are going to continue to reference the brilliant research work Grace has done, until we put a stop to the crime.

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