A Cohort Study of Anticholinergic Medication Burden and Incident Dementia and Stroke in Older Adults

Anticholinergic medication burden and cognitive function in participants of the ASPREE study

“…33 Alternatively, a vascular mechanism, such as reduced glucose metabolism and cerebral atrophy, 34 coincides with the results of our previous work, which demonstrated that anticholinergic burden increases the risk of vascular related dementia. 12 A vascular hypothesis would also explain the current findings on executive function, as decline in executive function is a common symptom of vascular dementia. 15 However, future research is needed to clearly establish the causal mechanism involved.…”

“…By investigating the impact of anticholinergic burden on specific cognitive domains, the present findings build upon our earlier work that showed an association between anticholinergic burden and incident dementia. 12 For all cognitive domains in combination (composite cognitive score), those with high or low-to-moderate anticholinergic burden had worse performance over time in cognition compared to those with no anticholinergic burden. Both composite executive/psychomotor functioning and composite memory had worse performance over time in those with high anticholinergic burden, though the effect was not seen with low-to-moderate anticholinergic burden.…”

“…We have recently shown that higher anticholinergic burden was associated with an increased risk of incident dementia, particularly for mixed/vascular dementia (which was the classification employed when there was a likely non-Alzheimer's contribution, typically small vessel vascular disease on neuroimaging), over a 4.7-year follow-up period in participants of the ASPirin in Reducing Events in the Elderly (ASPREE) trial. 12 In this analysis, we aimed to expand this earlier work to determine whether anticholinergic burden is associated with change over time in global cognition and within specific domains, including processing speed, executive function, and episodic memory. We hypothesize that higher anticholinergic burden would be associated with higher rates of cognitive decline in all domains, but especially executive functioning.…”

“…(2) our previous findings demonstrated that anticholinergic burden is most strongly associated with mixed/vascular dementia, 12 State examination (3MS) score of 78 or more on screening. 15 Further details on the ASPREE methods are published elsewhere.…”

Anticholinergic Burden of Geriatric Ward Inpatients

“…Boccardi et al in 2017 reported that impairment in Activities of Daily Living was more prevalent among users of anticholinergics, independently of their cognitive status [ 24 ]. Lockery [ 29 ] et al showed that older persons with ACB scores greater or equal to 3 were associated with dementia compared to persons with anACB load of 0 and that the risk of dementia was similar when comparing patients with ACB scores of 1 and 2. Boustani et al suggest that the total anticholinergic burden of an elderly patient with mild cognitive impairment, cognitive impairment, dementia, or delirium should be maintained below 3, and medications with ACB activity of 2 and 3 should be removed or replaced with medications with lower ACB scores where possible [ 8 ].…”