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Association between anticholinergic (atropinic) drug exposure and cognitive function in longitudinal studies among individuals over 50 years old: a systematic review

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Abstract

Purpose

With increasing age, adults are often exposed to anticholinergic drugs and are prone to potential adverse drug reaction, among which cognitive impairment. If the short-term cognitive effects of anticholinergic drugs are well established, their long-term cognitive effects have less been studied.

Objective

To provide a systematic review of longitudinal studies which assessed the effect of anticholinergic exposure on cognition in individuals over 50 years.

Materials

We searched the MEDLINE database for studies with a minimal 6-month follow-up, assessing anticholinergic exposure through a biological measure or a clinical list and reporting at least one cognitive outcome. We used the modified Newcastle-Ottawa scale and additional criteria regarding the anticholinergic exposure to assess studies’ methodological quality. Given the heterogeneity of the studies, we performed a systematic review.

Results

Among the 1574 references retrieved, 25 studies were included. Anticholinergic medications were mostly defined through the Anticholinergic Cognitive Burden Scale (n = 14/25). Six studies evaluated baseline drug collection, 14 used longitudinal aggregated measure, and 5 multiple drug exposure measures over time. Seventeen studies assessed anticholinergic burden. Cognitive function was assessed by mild cognitive impairment/dementia incidence (n = 15) or neuropsychological tests (n = 14). Most studies were of poor quality and retrieved discordant results. However, studies with good quality (n = 4) suggested a relationship between anticholinergic drug exposure and/or burden and cognitive function.

Conclusion

Our review suggests a deleterious effect of anticholinergic exposure on mid/long-term cognitive function but should be confirmed in studies with improved methodology. Meanwhile, prescription of anticholinergic drugs should remain cautious.

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Acknowledgements

The authors would like to thank Dr. Anne-Bahia Abdeljalil for her writing assistance.

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Authors and Affiliations

  1. UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France

    Laurine Andre, Adeline Gallini, François Montastruc, Jean-Louis Montastruc, Maryse Lapeyre-Mestre & Virginie Gardette

  2. Service d’Epidémiologie, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France

    Laurine Andre, Adeline Gallini & Virginie Gardette

  3. Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, Pharmacoépidémiologie et d’Informations sur le Médicament, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France

    François Montastruc & Jean-Louis Montastruc

  4. Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France

    Antoine Piau

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  1. Laurine Andre
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All authors contributed to the writing of the manuscript and approved the final version.

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Correspondence to Laurine Andre.

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Andre Laurine, Gallini Adeline, Montastruc François, Montastruc Jean-Louis, Piau Antoine, Lapeyre-Mestre Maryse, and Gardette Virginie have no conflicts of interest directly relevant to the content of this study.

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Andre, L., Gallini, A., Montastruc, F. et al. Association between anticholinergic (atropinic) drug exposure and cognitive function in longitudinal studies among individuals over 50 years old: a systematic review. Eur J Clin Pharmacol 75, 1631–1644 (2019). https://doi.org/10.1007/s00228-019-02744-8

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