Kris M Jamsen1,2, Danijela Gnjidic3,4, Sarah N Hilmer2,5, Jenni Ilomäki1, David G Le Couteur3,6,7, Fiona M Blyth3,6, David J Handelsman6,7, Vasi Naganathan3,6, Louise M Waite3,6, Robert G Cumming3,8, J Simon Bell1,2. 1. a Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences , Monash University , Parkville , VIC , Australia. 2. b National Health and Medical Research Council Cognitive Decline Partnership Centre , Hornsby Ku-ring-gai Hospital , Hornsby , NSW , Australia. 3. c Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute , Concord Hospital , Concord , NSW , Australia. 4. d Faculty of Pharmacy , University of Sydney , Sydney , NSW , Australia. 5. e Kolling Institute of Medical Research , Sydney Medical School, University of Sydney , Sydney , NSW , Australia. 6. f Sydney Medical School , University of Sydney , Sydney , NSW , Australia. 7. g ANZAC Research Institute , University of Sydney, Concord Hospital , Concord , NSW , Australia. 8. h Sydney School of Public Health , University of Sydney , Sydney , NSW , Australia.
Abstract
OBJECTIVE: Anticholinergic and sedative medications are associated with acute cognitive impairment, but the long-term impact on change in cognition is unclear. This study investigated the effect of anticholinergic and sedative medications, quantified using the Drug Burden Index (DBI), on change in cognition over time in community-dwelling older men. METHODS: This was a prospective cohort study of men aged ≥70 years in Sydney, Australia. DBI was assessed at baseline, 2, and 5 years. Cognitive performance was assessed using the Mini-Mental State Exam (MMSE) at each wave. Logistic quantile mixed-effects modelling was used to assess the adjusted effect of DBI on the median MMSE-time profile. Analyses were restricted to men with English-speaking backgrounds (n = 1059, 862, and 611 at baseline, 2, and 5 years). RESULTS: Overall, 292 (27.7%), 258 (29.9%), and 189 (31.3%) men used anticholinergic or sedative medications at baseline, 2, and 5 years. There was a concave relationship between MMSE and time, where higher DBI corresponded to lower MMSE scores (coefficient: -0.161; 95% CI: -0.250 to -0.071) but not acceleration of declining MMSE over time. CONCLUSIONS: Exposure to anticholinergic and sedative medications is associated with a small impairment in cognitive performance but not decline in cognition over time. KEY MESSAGES Exposure to anticholinergic and sedative medications, quantified using the Drug Burden Index, is associated with small cross-sectional impairments in cognitive performance. There was no evidence that exposure to anticholinergic and sedative medications is associated with accelerating decline in cognitive performance over a 5-year follow-up. Older people taking anticholinergic and sedative medications may derive immediate but small benefits in cognitive performance from clinical medication reviews to minimize or cease prescribing of these medications.
OBJECTIVE: Anticholinergic and sedative medications are associated with acute cognitive impairment, but the long-term impact on change in cognition is unclear. This study investigated the effect of anticholinergic and sedative medications, quantified using the Drug Burden Index (DBI), on change in cognition over time in community-dwelling older men. METHODS: This was a prospective cohort study of men aged ≥70 years in Sydney, Australia. DBI was assessed at baseline, 2, and 5 years. Cognitive performance was assessed using the Mini-Mental State Exam (MMSE) at each wave. Logistic quantile mixed-effects modelling was used to assess the adjusted effect of DBI on the median MMSE-time profile. Analyses were restricted to men with English-speaking backgrounds (n = 1059, 862, and 611 at baseline, 2, and 5 years). RESULTS: Overall, 292 (27.7%), 258 (29.9%), and 189 (31.3%) men used anticholinergic or sedative medications at baseline, 2, and 5 years. There was a concave relationship between MMSE and time, where higher DBI corresponded to lower MMSE scores (coefficient: -0.161; 95% CI: -0.250 to -0.071) but not acceleration of declining MMSE over time. CONCLUSIONS: Exposure to anticholinergic and sedative medications is associated with a small impairment in cognitive performance but not decline in cognition over time. KEY MESSAGES Exposure to anticholinergic and sedative medications, quantified using the Drug Burden Index, is associated with small cross-sectional impairments in cognitive performance. There was no evidence that exposure to anticholinergic and sedative medications is associated with accelerating decline in cognitive performance over a 5-year follow-up. Older people taking anticholinergic and sedative medications may derive immediate but small benefits in cognitive performance from clinical medication reviews to minimize or cease prescribing of these medications.
Authors: Lana Sargent; Mike Nalls; Elaine J Amella; Martina Mueller; Sarah K Lageman; Stefania Bandinelli; Marco Colpo; Patricia W Slattum; Andrew Singleton; Luigi Ferrucci Journal: J Gerontol A Biol Sci Med Sci Date: 2020-04-17 Impact factor: 6.053
Authors: Agostina Secchi; Hulkar Mamayusupova; Saber Sami; Ian Maidment; Simon Coulton; Phyo Kyaw Myint; Chris Fox Journal: Age Ageing Date: 2022-08-02 Impact factor: 12.782