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Antimuscarinic and dementia — DGM MCQ

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ModeratePolypharmacyAntimuscarinic and dementiaDGM

An 82-year-old woman with Alzheimer's disease has worsening confusion after treatment for urinary incontinence. She is also constipated and has dry mouth. No infection is found. Current medicines include tolterodine, donepezil and amlodipine. Which medication should be reviewed?

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Correct answer: A — Tolterodine

Tolterodine has antimuscarinic effects that can worsen cognition and oppose cholinesterase inhibitor treatment. Donepezil may cause gastrointestinal effects or bradycardia but does not explain anticholinergic symptoms; amlodipine, paracetamol and colecalciferol are less likely. Cognitive adverse effects should be considered before treating incontinence pharmacologically.

Reference: BNF; STOPP/START criteria v3