Geriatric psychiatrist Jacobo Mintzer, M.D., in an article in the July Journal of the Royal Society of Medicine, reviewed the often debilitating side effects of drugs with anticholinergic activity that are commonly seen when these medications are used in the elderly.

Mintzer noted that anticholinergic side effects may be significant in the elderly, including memory deficits, confusion and disorientation, agitation, hallucinations, and delirium. In extreme cases, Mintzer said, anticholinergic toxicity can depress brain function, leading to coma and circulatory collapse.

Even seemingly mild side effects can have significant ramifications for the elderly. Dry mouth, the most common side effect of anticholinergic medications, can lead to problems such as significant decreases in talking and refusal to eat, as well as agitation and depression. These conditions can easily be interpreted as a marked change in mental status. However, it may be as simple as saliva: the loss of moisture to adequately lubricate the patient’s dentures may have led to painful sores on the inside of the patient’s mouth.

Unfortunately, of the 25 medications most commonly prescribed to geriatric patients in the U.S., 13 have significant anticholinergic activity at the doses commonly prescribed.

Most psychotropic medications, Mintzer added, have marked anticholinergic activity. In one study of nearly 2,000 patients admitted to geriatric units, 28 percent were receiving at least one psychotropic medication. Thirteen percent of those patients had significant adverse reactions, many of them related to what Mintzer calls the "cholinergic bomb." The anticholinergic effects from psychotropic medications added to the anticholinergic effects of the most common drugs prescribed to the elderly result in an overwhelming, and often intolerable, challenge for the patient.