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

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Abstract

Background

Age-associated decline in central cholinergic activity makes older adults susceptible to the harmful effects of anticholinergic (AC) medications; however, there is an inadequate understanding of the 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 a multicenter database of community-dwelling older adults (N = 7351) aged 60+ years with QCI, from September 2005 to March 2014, as the baseline data. The Anticholinergic Drug Scale was used to categorize AC drug load into no, low, or moderate/high groups. Individuals with a Clinical Dementia Rating–Sum of Boxes score between 0.5 and 2.5 were identified as having QCI, while cognitive performance was evaluated using the 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 a higher prevalence of incontinence than those without AC exposure. Global cognition was significantly greater in the moderate/high-AC group than the no-AC group (−0.23 ± 0.53 vs. −0.32 ± 0.53). Multivariable linear regression showed that the global cognition score among the low- and moderate/high-AC groups, compared with the no-AC group, was 0.064 higher (p = 0.006 and p = 0.12, 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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Acknowledgments

The authors thank the participants and their families for their contributions to the research into AD, and the NAAC for providing us the data for this research. We also thank Dr. Catherine W. Striley, Assistant Professor, Department of Epidemiology, College of Public Health and Health Professions, University of Florida, for her skilled assistance and mentorship in this research.

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Authors and Affiliations

  1. Department of Epidemiology, University of Florida, Gainesville, FL, USA

    Sunil Swami & Todd M. Manini

  2. Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA

    Sunil Swami, Ronald A. Cohen & Todd M. Manini

  3. Center for Cognitive Aging and Memory, Aging and Geriatric Research, University of Florida, Gainesville, FL, USA

    Ronald A. Cohen

  4. Department of Biostatistics, University of Florida, Gainesville, FL, USA

    John A. Kairalla

Authors
  1. Sunil Swami
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  2. Ronald A. Cohen
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Corresponding author

Correspondence to Sunil Swami.

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Conflict of interest

Sunil Swami, Ronald Cohen, John Kairalla and Todd Manini declare that they have no potential conflicts of interest.

Funding

This research was not funded by any intramural or extramural source. The NACC database is funded by a National Institute on Aging/National Institute of Health (NIA/NIH) Grant U01 AG016976. NACC data are contributed by the NIA-funded ADCs: P30 AG019610 (principal investigator [PI] Eric Reiman, MD), P30 AG013846 (PI Neil Kowall, MD), P50 AG008702 (PI Scott Small, MD), P50 AG025688 (PI Allan Levey, MD, PhD), P30 AG010133 (PI Andrew Saykin, PsyD), P50 AG005146 (PI Marilyn Albert, PhD), P50 AG005134 (PI Bradley Hyman, MD, PhD), P50 AG016574 (PI Ronald Petersen, MD, PhD), P50 AG005138 (PI Mary Sano, PhD), P30 AG008051 (PI Steven Ferris, PhD), P30 AG013854 (PI M. Marsel Mesulam, MD), P30 AG008017 (PI Jeffrey Kaye, MD), P30 AG010161 (PI David Bennett, MD), P30 AG010129 (PI Charles DeCarli, MD), P50 AG016573 (PI Frank LaFerla, PhD), P50 AG016570 (PI David Teplow, PhD), P50 AG005131 (PI Douglas Galasko, MD), P50 AG023501 (PI Bruce Miller, MD), P30 AG035982 (PI Russell Swerdlow, MD), P30 AG028383 (PI Linda Van Eldik, PhD), P30 AG010124 (PI John Trojanowski, MD, PhD), P50 AG005133 (PI Oscar Lopez, MD), P50 AG005142 (PI Helena Chui, MD), P30 AG012300 (PI Roger Rosenberg, MD), P50 AG005136 (PI Thomas Montine, MD, PhD), P50 AG033514 (PI Sanjay Asthana, MD, FRCP), and P50 AG005681 (PI John Morris, MD).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. In addition, this is a retrospective study and formal consent is not required.

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Swami, S., Cohen, R.A., Kairalla, J.A. et al. Anticholinergic Drug Use and Risk to Cognitive Performance in Older Adults with Questionable Cognitive Impairment: A Cross-Sectional Analysis. Drugs Aging 33, 809–818 (2016). https://doi.org/10.1007/s40266-016-0400-3

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