ObjectivesTo measure the association between the use of drugs with anticholinerg ic properties and cognitive performance in an elderly population, the PAQUID cohort. MethodsThe sample studied was composed of 1780 subjects aged 70 and older, living at home in South western France. Data on socio-demographic characteristics, medical history and drug use were collected using a standardized questionnaire. Cognitive performance was assessed using the following neuropsycholog ical tests: the MiniMental State Examination (MMSE) which evaluates global cognitive functioning, the Benton Visual Retention Test (BVRT) which assesses immediate visual memory, and the Isaacs' Set Test (IST) which assesses verbal fluency. For each test, scores were dichotomized between low performance and normal to high performance using the score at the 10th percentile of the study sample as the cut-off point, according to age, gender and educational level. The association between the use of drugs with anticholinergic properties and cognitive performance was examined using logistic regression models, adjusting for several potential confounding factors. ResultsAbout 13.7% of the subjects used at least one drug with anticholinerg ic properties. In multivariate analyses, the use of these drugs was significantly associated with low performance in the BVRT [odds ratio (OR) = 1.6; 95% confidence interval (CI) 1.1, 2.3] and in the IST (OR = 1.9; 95% CI 1.3, 2.8). The association found with low performance in the MMSE (OR = 1.4; 95% CI 1.0, 2.1) was barely statistically significant. ConclusionThese findings suggest that the use of drugs with anticholinergic properties is associated with low cognitive performance among community-dwelling elderly people.

This study is the first attempt to evaluate the frequency of potentially inappropriate medication use in the elderly French population. Female gender and low socio-economic characteristics reduced the chances of receiving optimal pharmacotherapy. The proportion of elderly subjects receiving potentially inappropriate medication was higher than shown in previous studies. This is mainly explained by differences in the use of cerebral vasodilators.

Reimbursement data with an appropriate time frame and interviews estimate exposure to chronically used drugs similarly. Self-medication was better described with interviews whereas reimbursement data seem more useful for drugs used topically or intermittently.

This study suggests better management of late-life depression in the last decade and illustrates the heterogeneity of depression disorder in late life.