Which medication class should be used with caution in patients with cognitive impairment and certain comorbidities due to anticholinergic effects?

• A. Beta-3 adrenergic agonists
• B. Beta-blockers
• C. Diuretics
• D. Antimuscarinic agents

Answer: (D)

Antimuscarinic agents block muscarinic receptors, including those in the brain. In people with cognitive impairment, this central blockade can worsen memory, attention, and overall cognition and may trigger delirium, especially when other anticholinergic meds are present or when comorbidities like glaucoma or urinary retention are involved. Because of this, these drugs should be used with great caution in patients with cognitive impairment and relevant comorbidities, and clinicians often seek non-anticholinergic alternatives when possible. Other drug classes mentioned do not carry the same central anticholinergic burden, so they do not pose the same cognitive risk.