Impact of Long-Term Tiotropium Usage on Dementia Risk
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by Nhi Phuong Quynh Le, B.A |
Posted on June 13th, 2025
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Medications that interfere with acetylcholine signaling have been linked to cognitive decline. Long-acting antimuscarinic agents like tiotropium, commonly prescribed for chronic obstructive pulmonary disease (COPD), have known anticholinergic effects, but their impact on neurological function remains unclear. Previous studies on this topic have been limited by poor design. To address this gap, a study funded by the Brain Canada Foundation examined whether tiotropium use is associated with an increased risk of developing dementia.
This retrospective cohort study was conducted in Ontario, Canada, using health records collected between 2004 and 2012. The analysis included over 50,000 individuals, with roughly 30,000 patients using tiotropium for at least one year. These patients were matched with about 20,000 individuals who were treated with a combination of long-acting β2-agonists (LABAs) and inhaled corticosteroids (ICS). Both groups had similar concurrent medication profiles: approximately 40% also used short-acting β2-agonists, and 13% used short-acting antimuscarinics. Use of other neurotransmitter-related medications was low (under 5%).
Over a median follow-up period of 7.5 years, tiotropium users had a modestly increased risk of developing dementia compared to those on LABA-ICS combination therapy. The elevated risk was particularly evident among men below the age of 75. The researchers cautioned that this finding requires further investigation, especially considering the potential effects of the comparator drugs. While previous research suggested that LABA-ICS therapy does not affect cognitive function, that conclusion was based on short-term studies and may not reflect long-term outcomes.
This retrospective cohort study was conducted in Ontario, Canada, using health records collected between 2004 and 2012. The analysis included over 50,000 individuals, with roughly 30,000 patients using tiotropium for at least one year. These patients were matched with about 20,000 individuals who were treated with a combination of long-acting β2-agonists (LABAs) and inhaled corticosteroids (ICS). Both groups had similar concurrent medication profiles: approximately 40% also used short-acting β2-agonists, and 13% used short-acting antimuscarinics. Use of other neurotransmitter-related medications was low (under 5%).
Over a median follow-up period of 7.5 years, tiotropium users had a modestly increased risk of developing dementia compared to those on LABA-ICS combination therapy. The elevated risk was particularly evident among men below the age of 75. The researchers cautioned that this finding requires further investigation, especially considering the potential effects of the comparator drugs. While previous research suggested that LABA-ICS therapy does not affect cognitive function, that conclusion was based on short-term studies and may not reflect long-term outcomes.