Anticholinergic Drug Use and Risk to Cognitive Per

Authors: Sunil Swami Ronald A Cohen John A Kairalla Todd M Manini

Publish Date: 2016/09/17

Volume: 33, Issue: 11, Pages: 809-818

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Abstract

Ageassociated decline in central cholinergic activity makes older adults susceptible to the harmful effects of anticholinergic AC medications however there is an inadequate understanding of the association and possible effects of AC drugs on cognition This crosssectional study examines the associations of AC medications on cognition among older adults with questionable cognitive impairment QCIFor this crosssectional study we used a multicenter database of communitydwelling older adults N = 7351 aged 60+ years with QCI from September 2005 to March 2014 as the baseline data The Anticholinergic Drug Scale was used to categorize AC drug load into no low or moderate/high groups Individuals with a Clinical Dementia Rating–Sum of Boxes score between 05 and 25 were identified as having QCI while cognitive performance was evaluated using the Neuropsychological Test Battery The mean zscores of neuropsychological tests were grouped into a global cognition scoreParticipants who took AC medications were older largely female and had a higher prevalence of incontinence than those without AC exposure Global cognition was significantly greater in the moderate/highAC group than the noAC group −023 ± 053 vs −032 ± 053 Multivariable linear regression showed that the global cognition score among the low and moderate/highAC groups compared with the noAC group was 0064 higher p = 0006 and p = 012 respectivelyThis crosssectional study indicates that older adults with QCI who were exposed to AC medications might have higher global cognitive scores than those without AC exposure The observed associations indicate that older adults might experience some beneficial cognitive effects from AC drugs possibly due to the therapeutic effects of these medications in controlling comorbidities thus outweighing their adverse effects on cognitionThe authors thank the participants and their families for their contributions to the research into AD and the NAAC for providing us the data for this research We also thank Dr Catherine W Striley Assistant Professor Department of Epidemiology College of Public Health and Health Professions University of Florida for her skilled assistance and mentorship in this researchThis research was not funded by any intramural or extramural source The NACC database is funded by a National Institute on Aging/National Institute of Health NIA/NIH Grant U01 AG016976 NACC data are contributed by the NIAfunded ADCs P30 AG019610 principal investigator PI Eric Reiman MD P30 AG013846 PI Neil Kowall MD P50 AG008702 PI Scott Small MD P50 AG025688 PI Allan Levey MD PhD P30 AG010133 PI Andrew Saykin PsyD P50 AG005146 PI Marilyn Albert PhD P50 AG005134 PI Bradley Hyman MD PhD P50 AG016574 PI Ronald Petersen MD PhD P50 AG005138 PI Mary Sano PhD P30 AG008051 PI Steven Ferris PhD P30 AG013854 PI M Marsel Mesulam MD P30 AG008017 PI Jeffrey Kaye MD P30 AG010161 PI David Bennett MD P30 AG010129 PI Charles DeCarli MD P50 AG016573 PI Frank LaFerla PhD P50 AG016570 PI David Teplow PhD P50 AG005131 PI Douglas Galasko MD P50 AG023501 PI Bruce Miller MD P30 AG035982 PI Russell Swerdlow MD P30 AG028383 PI Linda Van Eldik PhD P30 AG010124 PI John Trojanowski MD PhD P50 AG005133 PI Oscar Lopez MD P50 AG005142 PI Helena Chui MD P30 AG012300 PI Roger Rosenberg MD P50 AG005136 PI Thomas Montine MD PhD P50 AG033514 PI Sanjay Asthana MD FRCP and P50 AG005681 PI John Morris MDAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards In addition this is a retrospective study and formal consent is not required

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