Anticholinergic Drug Use and Risk to Cognitive Performance in Older Adults with Questionable Cognitive Impairment: A Cross-Sectional Analysis

Abstract

Background Age-associated decline in central cholinergic activity makes older adults susceptible to harmful effects of anticholinergic (AC) medications. However, there is an inadequate understanding of association and possible effects of AC drugs on cognition. This cross-sectional study examines the associations of AC medications on cognition among older adults with questionable cognitive impairment (QCI). Methods For this cross-sectional study, we used multicenter database of community dwelling older adults (N=7,351) aged 60+ years with QCI from September 2005 until March 2014 as baseline data. Anticholinergic Drug Scale was used to categorize AC drug load in no, low or moderate/high groups. Individuals with clinical dementia rating-sum of boxes score between 0.5 and 2.5 were identify as having QCI. Cognitive performance was evaluated using Neuropsychological Test Battery. The mean z-scores of neuropsychological tests were grouped into a global cognition score. Results Participants who took AC medications were older, largely female and had higher prevalence of incontinence than those without AC exposure. Global cognition was significantly greater in moderate/high AC group than no AC group (-0.23±0.53 vs. -0.32±0.53). Multivariable linear regression showed that global cognition score among low and moderate/high AC groups, as compared to no AC group, was higher by 0.064 (P=.006 and P=.12, respectively). Conclusions This cross-sectional 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 cognition.

Anticholinergic Drugs in Geriatric Psychopharmacology

“…In a sample of primary care patients with first cognitive complaints, an elevated anticholinergic load was required for a significant association with cognitive dysfunction to be found (Grande et al, 2017). In contrast, in patients with questionable cognitive impairment (QCI), cognitive function improved when they received anticholinergics, due to the therapeutic effects on comorbid pathologies (Swami et al, 2016). According to this, Fox et al (2011a) have suggested that the anticholinergic action has to reach a critical threshold to produce cognitive effects.…”

“…In fact, cognitive dysfunction in AD is related with different aspects, such as decrease in the number of cholinergic neurons, acetylcholine receptor dysfunctions, and signaling dysregulation. Decline severity is proportional to the alteration of the cholinergic system (Swami et al, 2016). In this line, an anatomopathological study found that amyloid plaques were 2.5 times more frequent and neurofibrillary tangles were increased in patients with Parkinson’s disease treated with anticholinergic drugs in the long term compared to short-term treated or non-treated patients (Perry et al, 2003).…”

Anticholinergic drugs and functional, cognitive impairment and behavioral disturbances in patients from a memory clinic with subjective cognitive decline or neurocognitive disorders

“…In terms of population study, the relationship between AC burden and health disorders was assessed among patients with cognitive complaints at different diagnostic stages whereas, in previous studies, comparison of AC scales has been conducted in elderly people without SCD or ADRD [ 2 , 3 , 23 ]. The inclusion of patients at different stages of cognitive impairment allows us to study whether the effect of AC exposure may differ between these stages.…”

“…AC exposure was associated with increased risk of adverse events or deteriorating health conditions, i.e., falls, hospitalization, all-cause mortality, or worse cognitive and functional performance [ 2 – 4 ]. In contrast, Swami et al have shown that AC exposure was associated with higher global cognition among a large community-dwelling population of people aged 60 years or more [ 23 ]. The use of different scales to estimate the AC exposure leads to a large range of estimated proportion of patients with AC burden.…”

“…Different proportions of anticholinergic prescriptions in elderly patients with dementia have been highlighted, i.e., between 17% and 50% depending on the anticholinergic prescription measure and the population characteristics [ 16 , 19 – 22 ]. Previous studies comparing different AC scores and their associations with health outcomes have also highlighted discrepancies in the results [ 23 ]. Moreover, this comparison has not yet been conducted among patients from a memory clinic at different stages of cognitive disorders [ 2 , 3 , 24 , 25 ].…”