Detailed Cognitive Function and Use of Drugs with Anticholinergic Properties in Older People

Uusvaara, Juho; Pitkälä, Kaisu; Kautiainen, Hannu; Tilvis, Reijo S.; Strandberg, Timo

doi:10.1007/s40266-013-0055-2

Cited by 25 publications

(18 citation statements)

References 38 publications

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“…The observed findings support previous reports 1–16 regarding the association between AC medication use and cognitive impairments, with a significant effect of AC medication use on executive and immediate, rather than delayed, memory. We also found that the increased clinical progression from CN to MCI and/or AD was associated with AC medication use.…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults

Initiative¹

2016

JAMA Neurol

244

176

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Section: Discussionsupporting

confidence: 91%

“…Anticholinergic (AC) medications have been linked to impaired cognition 1–16 primarily in nondemented older adults 10,17 and an increased risk for cognitive impairment and dementia in older adults. 1,3,4,18–20 The biological basis for the cognitive effects of AC medications is unknown.…”

mentioning

confidence: 99%

Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults

Initiative¹

2016

JAMA Neurol

244

176

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“…[4-7] These effects include falls, confusion, cognitive impairment, sedation, delirium, and increased risk of frailty. [6,8,9] Because age and ADRD are both associated with central cholinergic deficiency, DAP use may exacerbate dementia-related symptoms.…”

Section: Introductionmentioning

confidence: 99%

Use of Drugs with Anticholinergic Properties Among Nursing Home Residents with Dementia: A National Analysis of Medicare Beneficiaries from 2007 to 2008

et al. 2014

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Background Older adults with dementia are vulnerable to the central deteriorating effects of drugs with anticholinergic properties (DAP). These effects include falls and confusion and may exacerbate dementia-related symptoms. Many individuals with dementia also receive acetylcholinesterase inhibitors (AChEI), indicated for mild to moderate Alzheimer's disease. AChEI have opposing effects to DAP and consequently, concomitant use of DAP and AChEI may further impair cognition among patients with dementia. Objectives Our objectives were to 1) evaluate the anticholinergic burden among nursing home (NH) residents with dementia; 2) characterize trends in use of DAP and concomitant use of DAP and AChEI among NH residents with dementia; and 3) identify factors associated with the use of DAP and concomitant use of DAP and AChEI. Methods We conducted a retrospective analysis of Medicare data from 2007-2008 linked to the Minimum Data Set. Results During the study period, 53,805 (77%) NH residents with dementia used at least one DAP each month. Sixty-seven percent of residents with dementia used Anticholinergic Burden Scale (ACBS) level 1 DAPs, 3% used level 2 and 31% used level 3 DAP. Thirteen percent of NH residents with dementia concomitantly used ACBS levels 2 or3 DAPs and AChEI. Conclusions This study sheds new light on the prevalence of DAP use and concomitant use of DAP and AChEI among NH residents with dementia. Clinicians should consider alternatives with lower anticholinergic effects, particularly in patients already taking DAP.

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“…Previous studies have demonstrated association between dementia and demographic factors, lifestyle behaviors, clinical conditions, and genetic biomarkers [23–25]. The demographic characteristics included age, sex, race, education, marital status, living situation, and family history.…”

Section: Methodsmentioning

confidence: 99%

“…Previous observational studies have reported that moderate/high AC burden is associated with greater risk of cognitive impairment and long-term cognitive decline in older adults [11–13, 23–25]. However, the pathophysiological process of AD and associated dementia begins years before the emergence of clinically detectable signs and symptoms [19]; and thus provide a window of opportunity to identify individuals with minimal cognitive impairment, and intervene and delay the process of cognitive decline in the very early stage of dementia.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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Detailed Cognitive Function and Use of Drugs with Anticholinergic Properties in Older People

Cited by 25 publications

References 38 publications

Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults

Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults

Use of Drugs with Anticholinergic Properties Among Nursing Home Residents with Dementia: A National Analysis of Medicare Beneficiaries from 2007 to 2008

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

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