Dementia Medication Reviews in Primary Care

A record diagnosis rate, and a gap that follows it

New data from NHS England, reported in Pharmacy Magazine, shows that two thirds (66.7%) of people aged 65 and over thought to have dementia now have a recorded diagnosis. That is a record level. As of the end of September 2026, 523,081 patients had a recorded dementia diagnosis, an increase of 6,851 since June.

The care that follows diagnosis has not kept pace. Of those patients, 329,398 (63%) had a care plan or care plan review in the previous 12 months. Only 162,607 of that group (49.4%) had received a medication review since April 2026.

That figure needs some context. The review window runs from 1 April, so it covers six months rather than a full year, and some practices will complete reviews later on. But the 49.4% is a share of patients who already had a care plan review. Measured against everyone with a recorded diagnosis, fewer than one in three are recorded as having had both a care plan review and a medication review this year.

For our clinical pharmacists, diagnosis is where the work begins. A dementia diagnosis should prompt a close look at every medicine a person takes, because some of those medicines may be making things harder.

Every week, our team at Clinical Pharmacist Solutions (CPS) carries out structured medication reviews in GP practices and primary care networks (PCNs). We regularly meet people with dementia taking medicines that were started years ago, for reasons that may no longer apply, and that can affect memory, confusion and falls risk. So the question we want to put to colleagues across primary care is simple. Once someone is diagnosed, are we doing enough to make sure their medicines are still helping them?

Why medicines matter so much in dementia

Many commonly prescribed medicines have anticholinergic effects. Each one may add only a little, but the effect builds across several medicines. This cumulative load is known as anticholinergic burden. In older people it can worsen constipation, urinary retention, sedation and confusion, all of which can make cognition, falls and the symptoms of dementia worse.

NICE guideline NG97 asks clinicians to be aware that some commonly prescribed medicines increase anticholinergic burden and cognitive impairment, and to consider minimising them or finding alternatives. PrescQIPP advises a medication review for people with dementia to identify drugs that may affect cognitive function. It also advises against prescribing anticholinergics alongside acetylcholinesterase inhibitors such as donepezil, rivastigmine and galantamine, which are among the main medicines used to treat dementia. The two work in opposite directions. Acetylcholinesterase inhibitors increase acetylcholine in the brain and anticholinergics block it, so one can cancel out the benefit of the other.

The risk is not always the obvious drugs. Bladder medicines such as oxybutynin and solifenacin carry a high burden, but lower-scoring medicines such as some opioids, antihistamines and loperamide can add up when taken together. A recent audit in one older people’s mental health team found almost three in four people referred for a dementia diagnosis were taking at least one medicine with anticholinergic burden. More than half of those had scores in the high-risk range.

Should a dementia diagnosis automatically trigger an anticholinergic burden review?

Antipsychotics and the question of duration

Antipsychotics are the other key concern. NICE describes reducing their use in people with dementia as a national priority. It notes that behavioural and psychological symptoms can often be prevented or managed without them. Where they are needed, NG97 expects the lowest effective dose for the shortest possible time.

In practice, treatment often runs longer. A 2025 cohort study in The Lancet Psychiatry found that more than half of people living with dementia who had more than one antipsychotic prescription continued beyond the NICE-recommended duration of one to three months.

Tools such as the STOPP/START criteria help clinicians spot this. Designed for reviewing medicines in older people, STOPP flags antipsychotics for behavioural and psychological symptoms of dementia as potentially inappropriate unless symptoms are severe and non-drug approaches have already been tried. It also flags medicines with anticholinergic effects in people with dementia.

As with many high-risk medicines, the harm often lies less in the first prescription and more in the repeats that follow without review. Should every antipsychotic started for distress in dementia carry a review date and a plan to reduce?

What a good dementia medication review looks like

Reviewing medicines for someone with dementia takes time. Patients may struggle to recall why a medicine was started or to describe side effects, so carers and family are often essential to the conversation. Swallowing difficulties, pill burden and who manages medicines at home matter as much as the clinical picture.

Our pharmacists start by understanding what matters to the person and the people who care for them. That means checking each medicine still has a clear purpose, looking at the combined effect of everything prescribed and simplifying regimens where possible. It also means thinking ahead. As dementia progresses, the balance of benefit and risk shifts for preventive medicines, and those conversations are best had early, while the person can still take part.

Deprescribing is not about taking things away. It is about making sure every medicine still earns its place, and supporting people to live as well as possible for as long as possible.

Making reviews part of the pathway

Missed reviews rarely come from a lack of will. They tend to follow capacity pressures, competing priorities and medicines checks that get folded into a wider care plan appointment. That raises questions we would like to explore with other clinicians.

Is a medication review built into every new dementia diagnosis, or does it wait for the annual care plan review?
When a GP completes the care plan review, is a pharmacist medication review happening alongside it, or are the two done separately?
Are we routinely calculating anticholinergic burden, and acting on high scores?
Are antipsychotics started for distress reviewed within the recommended timeframe, and are they still clinically appropriate?
Are carers involved in medication decisions, especially for people living at home?

This needs more than individual reviews

Pharmacists are well placed to lead this work, but closing the gap needs a consistent approach across practices, PCNs and integrated care boards (ICBs). Structured medication reviews already exist for people with complex polypharmacy, and many people with dementia fit that description.

How this is measured is also changing. From July 2026, NHS England publishes primary care dementia data quarterly rather than monthly. Antipsychotic prescribing is now reported at sub-ICB level rather than by GP practice. With less published data to benchmark against, local audit and oversight matter more than ever.

As ICBs shape their medicines optimisation priorities, we think a few questions deserve wider discussion.

How do we make sure every practice or PCN has the pharmacist capacity to review medicines for people on the dementia register?
Should people with dementia be prioritised for medication reviews alongside other high-risk groups, such as care home residents and people living with frailty?

Carers are often the ones managing medicines day to day. Our team has run sessions for unpaid carers in London, and they show how much carers want clearer support around medicines.

Do carers have the support they need to manage medicines well for the people they care for?

We want to hear from you

We would like to hear from GPs, clinical pharmacists, old age psychiatrists, memory clinic teams, dementia nurses, care home teams, ICB medicines optimisation teams and anyone else supporting people living with dementia.

What has worked in your practice or PCN?
Where do you see medicines being missed after diagnosis?
What would make medication reviews for people with dementia easier to deliver?

Share your thoughts in the comments on our LinkedIn post, or get in touch to talk about how our clinical pharmacists support structured medication reviews for people living with dementia in primary care.

References
NHS England Digital. Primary Care Dementia Data, September 2026. Published October 2026. https://digital.nhs.uk/data-and-information/publications/statistical/primary-care-dementia-data/september-2026
NHS England. NHS supports record numbers of people living with dementia as target achieved. October 2026. https://wired-gov.net/wg/news.nsf/articles/NHS+supports+record+numbers+of+people+living+with+dementia+as+target+achieved+22102026171500?open=
National Institute for Health and Care Excellence (NICE). Dementia: assessment, management and support for people living with dementia and their carers. NICE guideline NG97, 2018. https://www.nice.org.uk/guidance/ng97
PrescQIPP. Bulletin 253. Anticholinergic burden. https://www.prescqipp.info/media/5209/253-anticholinergic-burden-20.pdf
Anticholinergic burden rationalisation before dementia treatment in an old age psychiatry community team. BJPsych Open, 2025, 11(S1). https://pmc.ncbi.nlm.nih.gov/articles/PMC12260016/
National Institute for Health and Care Excellence (NICE). Dementia: anti-psychotic prescriptions. NICE indicator IND12. Last updated 2024. https://www.nice.org.uk/indicators/ind12-dementia-anti-psychotic-prescriptions/chapter/indicator
Smith HC, et al. Antipsychotic prescriptions in people with dementia in primary care. A cohort study investigating adherence of dose and duration to UK clinical guidelines. The Lancet Psychiatry, 2025, 12(10), 758–767. https://doi.org/10.1016/S2215-0366(25)00261-5
O’Mahony D, et al. STOPP/START criteria for potentially inappropriate prescribing in older people, version 3. European Geriatric Medicine, 2023, 14(4), 625–632. https://doi.org/10.1007/s41999-023-00777-y
NHS England Digital. Primary Care Dementia Data. Consultation 2026. https://digital.nhs.uk/data-and-information/publications/statistical/primary-care-dementia-data/pcdd-consultation-2026