Background. In 1990s, complementary and alternative medicine (CAM), including use of herbs and supplements, gained popularity in the United States. However, more recent surveys suggest that demand for herbs and supplements has stabilized. Objective. This study examined the prevalence, patterns, and changes in herb and supplement use among the US adults, using the 2002, 2007, and 2012 National Health Interview Surveys (NHIS). Methods. Weighted population estimates were derived from three complementary and alternative medicine supplements to the NHIS. Prevalence rates for herb and supplement use were compared, using Wald chi-square tests to measure changes between years. Results. An estimated 40.6 million US adults reported herb and supplement use in 2012. However, the rate of herb and supplement use dropped from 18.9% in 2002 to 17.9% in 2007 and 2012 (P < 0.05). This decline in use was more pronounced among women, racial or ethnic minorities, and adults with low incomes. Conclusion. Herb and supplements use remains common in the USA, but adult use rates are on the decline. It is still important for health care providers to ask patients about herb and supplement use.

Study Objectives To evaluate the association between anticholinergic medication use, categorized by anticholinergic cognitive burden (primary objective) and cumulative dose (secondary objective), and the risk of developing dementia among patients with Parkinson's disease. Design Retrospective cohort study with an active comparator design. Data Source National Health Insurance Research Database in Taiwan (2001–2011). Patients A total of 1232 adults with Parkinson's disease who were diagnosed between 2002 and 2004 and taking at least one antiparkinson medication during this period were included. Of these patients, 694 were exposed to anticholinergic medications categorized as mild (reference group), and 538 were exposed to anticholinergic medications categorized as moderate or severe (exposure group). Measurements and Main Results Exposure to different types of anticholinergic medications was categorized by using the Anticholinergic Cognitive Burden (ACB) scale, and cumulative doses of anticholinergic medications were measured by using the cumulative minimum doses (cMD) method. Associations between anticholinergic medication use and risk of dementia were assessed by multivariable Cox proportional hazards models. The type of anticholinergics used (moderate or severe vs mild ACB) was not significantly associated with an increased risk of developing dementia (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.72–1.27). After adjusting for confounders, a high cumulative dose of anticholinergic drug (> 1095 cumulative minimum doses [cMDs]) was found to be significantly associated with an increased risk of developing dementia when compared with a low cumulative dose of anticholinergic drug (≤ 90 cMDs) (HR 3.06, 95% CI 1.35–6.97). Conclusion Among patients with Parkinson's disease in Taiwan, those with a high cumulative dose of anticholinergics had an increased risk of being diagnosed with dementia. Physicians should consider prescribing the lowest therapeutic dose of anticholinergic medication when making treatment decisions for patients with Parkinson's disease.

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