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Older people with dementia may be particularly susceptible to cognitive impairment associated with anticholinergic and sedative medicines.This impairment may be misattributed to the disease process itself.Medicines with sedative properties have been linked to depressive symptoms, worsening cognition, respiratory depression, impaired muscle strength and falls and fractures.All medicines with sedative properties – not only those prescribed for intentional sedation – may contribute to an older person's sedative load.However, clinicians may be less aware that some medicines prescribed for other purposes also have anticholinergic properties These include the inhaled anticholinergics, ipratropium and tiotropium bromide when prescribed in their usual therapeutic doses.Even medicines with minor anticholinergic properties may contribute to unwanted central and peripheral adverse events if used in combination with other agents with anticholinergic effects.Anticholinergic medicines can cause constipation, which can result in urinary retention and urge and overflow incontinence.Cholinesterase inhibitors prescribed for patients with Alzheimer disease have also been associated with urinary incontinence.
Causes of dementia include Alzheimer disease, dementia with Lewy bodies, frontotemporal dementia, vascular dementia and Parkinson disease.
Prompted or timed voiding may reduce urinary incontinence among residents of aged care facilities with dementia.
For people with functional incontinence related to impaired mobility, an occupational therapist or physiotherapist may advise measures to improve toilet access (eg.
Cholinesterase inhibitors (donepezil, rivastigmine and galantamine) may modestly improve cognition via inhibiting the enzyme acetyl cholinesterase.
Restricted supply of these medicines is subsidised through the Pharmaceutical Benefits Scheme (PBS) using the authority system for the management of mild to moderate Alzheimer disease.