Anticholinergic and Sedative Medications Are Associated With Neurocognitive Performance of Well Treated People With Human Immunodeficiency Virus

Abstract

Background We previously showed that anticholinergic (ACH) medications contribute to self-reported neurocognitive impairment (NCI) in elderly people living with HIV (PLWH). The current cross-sectional study further evaluated the effect of ACH and sedative drugs on neurocognitive function in PLWH who underwent comprehensive neuropsychological evaluation. Methods A medication review was performed in PLWH enrolled in the prospective Neurocognitive Assessment in Metabolic and Aging Cohort (NAMACO) within the Swiss HIV Cohort Study. Neurocognitive functions were analyzed in 5 domains (motor skills, speed of information, attention/working memory, executive functions and verbal learning memory). The effect of ACH and sedative medications on neurocognitive functioning was evaluated using linear regression models for the continuous (mean z-score) outcome and multivariable logistic regression models for the binary (presence/absence) outcome. Results 963 PLWH (80% male, 92% Caucasian, 96% virologically suppressed, median age 52) were included. 14% of participants were prescribed ≥1 ACH medication and 9% were prescribed ≥1 sedative medication. Overall, 40% of participants had NCI. Sedative medication use was associated with impaired attention/verbal learning and ACH medication use with motor skills deficits both in the continuous (mean z-score difference -0.26 to -0.14, p < 0.001 and p = 0.06) and binary (odds ratio, OR ≥1.67, p < 0.05) models. Their combined use was associated with deficits in overall neurocognitive functions in both models (mean z-score difference -0.12, p = 0.002 and OR 1.54, p = 0.03). These associations were unchanged in a subgroup analysis of participants without depression (n = 824). Conclusion ACH and sedative medications contribute to NCI. Clinicians need to consider these drugs when assessing NCI in PLWH.

Anticholinergic medications associated with falls and frailty in people with HIV

“…There are some data showing associations between their use and self-reported [19,22] and objective cognitive impairment [17,20,23]. Consistent with our findings, Jakeman et al identified most ACMs used by those aged >65 years within the Swiss HIV Cohort Study (SHCS) [19] and subsequently a subset of those aged >45 years of the SHCS who underwent formal cognitive testing [20], as being of low anti-cholinergic potential. Looking at the use of ACMs and other "neurocognitive adverse effect medications", Psomas et al recently reported a relationship between ACM use and falls in a cohort of women with HIV in the USA.…”

“…Literature on the association between ACM use and age-related co-morbidities among people living with HIV is sparse. There are some data showing associations between their use and self-reported [19,22] and objective cognitive impairment [17,20,23]. Consistent with our findings, Jakeman et al identified most ACMs used by those aged >65 years within the Swiss HIV Cohort Study (SHCS) [19] and subsequently a subset of those aged >45 years of the SHCS who underwent formal cognitive testing [20], as being of low anti-cholinergic potential.…”

“…The prevalence of ACM use in older people with HIV is estimated to be between 15% and 30% [16][17][18]. In this population, there is some evidence of an association between ACM use and self-reported cognitive impairment [19], worse neuro-psychometric performance [20][21][22], and reduced structural brain volume and fractional anisotropy on magnetic resonance imaging, although the latter may demonstrate reversibility following reduction of ACM use [23]. While polypharmacy and use of "cognitive adverse effects medications" (including ACMs) increased the odds of recurrent falls in one large US cohort of people with HIV [24], other studies that have considered associations between ACM use and falls and frailty in this population are rare.…”

Potentially Inappropriate Prescribing in Older People Living With HIV: A Scoping Review

“…Most studies were single centre 22,29,31–33,39–42,44,45,48–52,54,57,59–66 and conducted in Europe. 13,19,28,30–33,39,41,43–51,53,56–63,65,67 The sample size ranged from 2 to 1292 participants, and the population was majority male. Twenty-eight studies were cross-sectional, 19,27,28,30–33,39–41,44,45,47–51,53,55,56,61–67 3 were prospective cohort studies, 43,46,57 3 were prospective intervention studies with no control group, 22,59,60 2 nonrandomized controlled studies, 42,52 and 1 randomized controlled study, 58 1 case–control study, 29 and 1 case-report.…”

“…13,19,28,30–33,39,41,43–51,53,56–63,65,67 The sample size ranged from 2 to 1292 participants, and the population was majority male. Twenty-eight studies were cross-sectional, 19,27,28,30–33,39–41,44,45,47–51,53,55,56,61–67 3 were prospective cohort studies, 43,46,57 3 were prospective intervention studies with no control group, 22,59,60 2 nonrandomized controlled studies, 42,52 and 1 randomized controlled study, 58 1 case–control study, 29 and 1 case-report. 54 In most studies, investigators used explicit criteria (Table 1), and in others, implicit criteria or a combination of both (Table 2).…”