BACKGROUND: Anticholinergic burden is associated with poorer cognitive and functional outcomes in people with dementia. However, the impact of anticholinergics on significant adverse outcomes such as stroke has not been studied previously. OBJECTIVE: To investigate the association between total anticholinergic cognitive burden (ACB) and risk of stroke and death in people with different dementia subtypes. METHODS: This was a cohort study of 39,107 people with dementia and no prior history of stroke registered in the Swedish Dementia Registry (SveDem) from 2008-2014. Data were extracted from the Swedish Prescribed Drug Register, the Swedish National Patient Register, and the Swedish Total Population Register. Competing risk regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-varying ACB score and risk of stroke and all-cause mortality. RESULTS: During a mean follow-up period of 2.31 (standard deviation 1.66) years, 11,224 (28.7%) individuals had a stroke or died. Compared with non-users of anticholinergic medications, ACB score of 1 (HR 1.09, 95% CI 1.04-1.14) and ACB score of ≥2 (HR 1.20, 95% CI 1.14-1.26) increased the risk of developing the composite outcome of stroke and death. When stratifying by dementia disorder, the association remained significant in Alzheimer's disease, mixed dementia, and vascular dementia. CONCLUSIONS: The use of anticholinergic medicines may be associated with an increased risk of stroke and death in people with dementia. A dose-response relationship was observed. Careful consideration should be made when prescribing medications with anticholinergic properties to people with dementia.
BACKGROUND: Anticholinergic burden is associated with poorer cognitive and functional outcomes in people with dementia. However, the impact of anticholinergics on significant adverse outcomes such as stroke has not been studied previously. OBJECTIVE: To investigate the association between total anticholinergic cognitive burden (ACB) and risk of stroke and death in people with different dementia subtypes. METHODS: This was a cohort study of 39,107 people with dementia and no prior history of stroke registered in the Swedish Dementia Registry (SveDem) from 2008-2014. Data were extracted from the Swedish Prescribed Drug Register, the Swedish National Patient Register, and the Swedish Total Population Register. Competing risk regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-varying ACB score and risk of stroke and all-cause mortality. RESULTS: During a mean follow-up period of 2.31 (standard deviation 1.66) years, 11,224 (28.7%) individuals had a stroke or died. Compared with non-users of anticholinergic medications, ACB score of 1 (HR 1.09, 95% CI 1.04-1.14) and ACB score of ≥2 (HR 1.20, 95% CI 1.14-1.26) increased the risk of developing the composite outcome of stroke and death. When stratifying by dementia disorder, the association remained significant in Alzheimer's disease, mixed dementia, and vascular dementia. CONCLUSIONS: The use of anticholinergic medicines may be associated with an increased risk of stroke and death in people with dementia. A dose-response relationship was observed. Careful consideration should be made when prescribing medications with anticholinergic properties to people with dementia.
Authors: Martin Taylor-Rowan; Olga Kraia; Christina Kolliopoulou; Anna H Noel-Storr; Ahmed A Alharthi; Amanda J Cross; Carrie Stewart; Phyo K Myint; Jenny McCleery; Terry J Quinn Journal: Cochrane Database Syst Rev Date: 2022-08-22
Authors: Jessica E Lockery; Jonathan C Broder; Joanne Ryan; Ashley C Stewart; Robyn L Woods; Trevor T-J Chong; Geoffrey C Cloud; Anne Murray; Jason D Rigby; Raj Shah; Elsdon Storey; Stephanie A Ward; Rory Wolfe; Christopher M Reid; Taya A Collyer; Michael E Ernst Journal: J Gen Intern Med Date: 2021-03-22 Impact factor: 6.473
Authors: Hong Xu; Sara Garcia-Ptacek; Linus Jönsson; Anders Wimo; Peter Nordström; Maria Eriksdotter Journal: Neurology Date: 2021-03-19 Impact factor: 9.910
Authors: Shimaa A Heikal; Mohamed Salama; Yuliya Richard; Ahmed A Moustafa; Brian Lawlor Journal: Front Aging Neurosci Date: 2022-02-07 Impact factor: 5.750