Anticholinergics Exposure and the Risk of Cognitive Decline

BACKGROUND: The role of modifiable risk factors for patients

with dementia and at risk of dementia requires investigation

with large population studies.

OBJECTIVES: To examine the association between anticholinergic

medication use and cognitive decline in the older population

DESIGN: A two-year longitudinal study of participants enrolled

in the Medical Research Council (MRC) Cognitive Function

and Ageing Study (CFAS) between 1991 and 1993.

SETTING: Community and institionalized participants.

PARTICIPANTS: A sample of 13,004 participants aged 65 years

and older.

MEASUREMENTS: Baseline use of possible or definite anticholinergics

as determined by the Anticholinergic Cognitive Burden

(ACB) scale, and cognition as determined by the Mini-Mental State

Examination (MMSE). The main outcome measure was decline on

the mini-mental state examination at 2 years.

RESULTS: At baseline, 47% of the population used a medication

with possible anticholinergic properties and 4% used a drug with

definite anticholinergic properties. After adjusting for age, sex, educational

level, social class, number of non-anticholinergic medications,

number of co-morbid health conditions and cognitive performance at

baseline, the use of medication with definite anticholinergic effects

was associated with an additional reduction in MMSE score of 0.43

points (95% CI 0.11, 0.75; p<0.008) compared to those not taking anticholinergics,

whereas the use of possible anticholinergics at baseline

was not associated with further MMSE decline (estimate=0.00 95%

CI -0.11, 0.11; p=0.98). Two year mortality was increased both for

those taking definite anticholinergic medications (OR 1.68; 95% CI

1.30, 2.16; p<0.001) and for those taking possible anticholinergic medications

(OR 1.56; 95% CI: 1.36, 1.79; p<0.001).

CONCLUSION: The benefits of prescribing definite anticholinergics

may lead to unintended negative consequences on both cognitive

function and mortality among the older population.