Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID Study

Abstract

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.

Medication Use in Patients Presenting to a Rural and Remote Memory Clinic

“…18 A study of a large population of elderly outpatients found that 13.7% of the subjects were on anticholinergic drugs. 12 A recent study of anticholinergic drug prescriptions indicated that 35.4% of patients receiving an acetylcholinesterase inhibitor also received an anticholinergic drug. 19 Our figure of 24.2% shows a lower result in a rural and remote population with cognitve symptoms.…”

“…9 In addition, drugs with anticholinergic activities are relatively contraindicated in the elderly even in the absence of dementia. [10][11][12] A significant number of drugs without prominent anticholinergic effects have also been shown to contribute to cognitive impairment in elderly patients. 13 Benzodiazepines, in particular, have been implicated as potentially problematic in older adults.…”

Difficulties in Understanding Postoperative Cognitive Dysfunction

“…Cholinesterase inhibitors have been shown to improve cognitive function (20). Several clinical studies showed that drugs with anti-cholinergic effects had negative effects on the cognitive function of patients (33)(34)(35). Thus, it's possible that cholinergic function impairment may participate in the development of POCD.…”

“…Cholinergic pathway participates in various cognitive processes including short-term memory, learning and attention (33). The deterioration and impairment of central cholinergic system is not only related to normal aging (33), but also to neurodegenerative diseases such as AD (20). Cholinesterase inhibitors have been shown to improve cognitive function (20).…”

Anti-Cholinergic Load, Health Care Utilization, and Survival in People with Advanced Cancer: A Pilot Study

“…4 There is also a link with poor cognitive outcomes, especially in the group with existing cognitive impairment. 4,5,[26][27][28][29][30][31][32] Anti-cholinergic medications can precipitate delirium and intensify pre-existing delirium. 8,25,[33][34][35][36][37][38][39][40] An episode of delirium is linked to significant morbidity and mortality, and is associated with increased length of hospital stay, institutionalisation, irreversible functional and cognitive decline, and mortality in the elderly.…”