The medicines you take today could have implications for your brain health tomorrow.
A recent safety update from the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) has prompted healthcare professionals to carefully consider the use of anticholinergic medications in older adults. While the regulator concluded that the evidence does not prove these medications directly cause dementia, it also stated that a small increased risk cannot be ruled out.
The advice is clear: where appropriate, older adults should take the lowest effective dose for the shortest possible time and avoid unnecessary combinations of anticholinergic medications.
For those of us working in functional medicine and preventative healthcare, this raises an important question:
How do we protect cognitive health while still managing symptoms effectively?
What are anticholinergic medications?
Anticholinergic drugs work by blocking the action of acetylcholine, one of the body’s most important neurotransmitters.
Acetylcholine plays a vital role in:
- Memory
- Learning
- Attention
- Concentration
- Muscle contraction
- Bladder function
- Digestive function
Blocking acetylcholine can be extremely helpful in certain conditions, which is why these medications are widely prescribed. However, because acetylcholine is so important for brain function, researchers have questioned whether long-term suppression could contribute to cognitive decline.
Which medications have anticholinergic effects?
Many people are surprised to learn that anticholinergic properties are found in medications prescribed for a wide range of conditions.
These include certain:
- Bladder medications (such as oxybutynin and tolterodine)
- Tricyclic antidepressants including amitriptyline
- Some SSRIs, particularly paroxetine
- First-generation antihistamines
- Certain Parkinson’s medications
- Antipsychotic medications
- Some anti-nausea medications
- Certain muscle relaxants
Importantly, many people are prescribed more than one medication with anticholinergic properties without realising it.
This is known as anticholinergic burden.
Why does anticholinergic burden matter?
One medication with mild anticholinergic effects may not cause significant problems for most people.
However, as medications accumulate over the years, the total anticholinergic burden increases.
Ageing itself makes this more important because:
- The brain becomes more vulnerable.
- The liver and kidneys clear medications more slowly.
- Older adults are more susceptible to side effects such as confusion, dizziness and falls.
- Multiple medications often interact with one another.
This is why healthcare professionals are increasingly considering cumulative medication burden rather than individual prescriptions in isolation.
What does the research actually show?
This is where it is important to avoid oversimplification.
Current research demonstrates an association, not proof of causation.
Several large observational studies have shown that people with greater cumulative exposure to medications with strong anticholinergic effects are more likely to develop dementia later in life. The association appears strongest for:
- Bladder antimuscarinics
- Certain antidepressants
- Antipsychotics
- Parkinson’s medications
- Some antiepileptic drugs
Many studies also suggest that the risk increases with both higher cumulative exposure and longer duration of use.
However, researchers cannot yet determine whether the medications themselves contribute to dementia or whether the medical conditions requiring treatment represent early manifestations of neurodegenerative disease.
This uncertainty is precisely why the MHRA stopped short of confirming causation while still recommending a cautious prescribing approach.
A functional medicine perspective
One of the strengths of functional medicine is that we ask an additional question:
Why has the symptom developed in the first place?
Medication often plays an essential role and should never be dismissed. However, wherever possible, we also investigate the underlying drivers that may be contributing to the condition.
For example, overactive bladder is commonly treated with anticholinergic medication.
While this may be entirely appropriate, it is also worth exploring factors such as:
- Menopausal hormonal changes
- Pelvic floor dysfunction
- Blood glucose dysregulation
- Chronic constipation
- Recurrent urinary tract infections
- Alterations in the urinary microbiome
- Sleep disorders
- Excess caffeine or bladder irritants
- Obesity
- Chronic inflammation
Addressing these underlying factors may not replace medication for everyone, but it may reduce symptom severity and, in some cases, lower the need for long-term pharmacological treatment.
Protecting acetylcholine naturally
Although no supplement can replace appropriate medical treatment, supporting healthy acetylcholine production and protecting the brain involves many lifestyle factors.
These include:
Regular exercise
Exercise improves cerebral blood flow and stimulates brain-derived neurotrophic factor (BDNF), helping maintain healthy neural networks.
Good sleep
Deep sleep supports memory consolidation and acetylcholine regulation.
Mediterranean-style nutrition
Diets rich in colourful vegetables, extra virgin olive oil, fish, nuts and polyphenols are consistently associated with better cognitive ageing.
Blood sugar regulation
Stable glucose and insulin levels reduce inflammation and support long-term brain health.
Managing cardiovascular risk
Healthy blood pressure, cholesterol and vascular function all contribute to maintaining cognitive resilience.
Lifelong cognitive stimulation
Learning new skills, maintaining social engagement and challenging the brain all appear protective.
Should you stop your medication?
Absolutely not without discussing it with your healthcare professional.
Many anticholinergic medications significantly improve quality of life and remain the most appropriate treatment for certain individuals.
Instead, this information should encourage:
- Regular medication reviews
- Avoiding unnecessary duplication of anticholinergic medications
- Considering alternatives where appropriate
- Addressing underlying contributors wherever possible
- Balancing symptom control with long-term health goals
The bigger picture
Brain health is rarely determined by one medication or one decision.
It reflects the accumulation of thousands of small influences over a lifetime—nutrition, exercise, sleep, vascular health, environmental exposures, inflammation, stress, genetics and, yes, medications.
The goal is not to create fear around necessary treatment.
Rather, it is to encourage informed conversations between patients and healthcare professionals about the balance between symptom management today and protecting cognitive health for the future.
At CogMission, our philosophy is always the same: manage symptoms when necessary, but never stop searching for the root cause.
Because preserving brain health starts long before memory problems ever appear.