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Anticholinergic burden in dementia — DGM MCQ

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ModerateDementiaAnticholinergic burden in dementiaDGM

An 88-year-old man with dementia has worsening confusion, dry mouth and urinary retention. He was recently started on solifenacin for urgency incontinence. His medicines also include donepezil, ramipril, colecalciferol and macrogol. Which medication should be reviewed?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Solifenacin

Solifenacin has anticholinergic effects that can worsen cognition and urinary retention, and it directly counteracts cholinesterase inhibitor therapy. Donepezil can cause urinary symptoms or bradycardia, but the anticholinergic symptom pattern makes solifenacin the best answer. Reviewing anticholinergic burden is central in dementia care.

Reference: BNF; NICE NG97; STOPP/START criteria v3