Association between using medications with anticholinergic properties and short‐term cognitive decline among older men: A retrospective cohort study in Taiwan

Abstract

Aim The use of anticholinergic drugs had been strongly linked to adverse health outcomes among older adults, especially in cognitive impairment or dementia. The present study aimed to evaluate the cognitive decline related to the use of anticholinergic drugs among older men living in the veterans’ homes in Taiwan. Methods This retrospective cohort study was a substudy of The Longitudinal Older Veterans study. A total of 274 residents living in four Taiwan veterans’ homes and receiving two consecutive Mini‐Mental State Examinations within the interval of 6 months from January 2012 to December 2014 were enrolled in the present study. The medication lists for all participants were reviewed by the same physician, and the anticholinergic properties of the individual medications were evaluated by using the Anticholinergic Cognitive Burden scale. Cognitive decline was defined as the decrease of Mini‐Mental State Examinations scores during the study period. Results Overall, 139 persons (50.7%) had exposure to anticholinergic drugs at baseline (designated as AC[+]), and the most frequently used anticholinergic drugs were cardiovascular drugs (48.2%), antipsychotics (21.6%), theophylline (20.1%), antidepressants (12.2%), gastrointestinal drugs (11.5%) and antihistamines (8.6%). After adjusting for covariates, AC(+) participants had a significantly higher risk for short‐term cognitive decline (OR 2.69, 95% CI 1.36–5.31). After excluding 30 participants using antipsychotics, non‐antipsychotics AC(+)participants still had a significantly higher risk for short‐term cognitive decline (OR 2.24, 95% CI 1.26–3.99). Conclusions Exposure to anticholinergic drugs significantly increased the risk for short‐term cognitive decline among older men, and the adverse effects remained similar when antipsychotics were excluded for analysis. A further intervention study is required to evaluate whether reducing anticholinergic burden might improve cognitive function among older adults. Geriatr Gerontol Int 2017: 17 (Suppl. 1): 57–64.

Anticholinergic exposure and cognitive decline in older adults: effect of anticholinergic exposure definitions in a 3‐year analysis of the multidomain Alzheimer preventive trial (MAPT) study

“…We found a lower prevalence of anticholinergic exposure in MAPT participants compared with previous studies using comparable anticholinergic burden scales in older adults . However, comparison with the literature is difficult, as most studies included both institutionalized and community‐dwelling participants , or specific populations (e.g.…”

“…Other studies analysed global cognition using the MMSE or Saint Louis University Mental Status (SLUMS) examination , but results were inconsistent: one study found a significant association between baseline anticholinergic exposure and cognition measured with MMSE progression, whereas two studies with longer follow‐ups found no association . One study evaluated baseline anticholinergic burden and MMSE progression at 2 years in community‐dwelling adults aged 65 years or older in the UK .…”

“…However, such designs are not well suited to assess this association. Moreover, some longitudinal studies [11,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] have been conducted but results were discordant, and they used various anticholinergic exposure measures but rarely measured anticholinergic burden.…”

Prevalence, risk factors and adverse outcomes of anticholinergic burden in patients with advanced chronic conditions at hospital admission

“…The use of anticholinergic drugs is associated with various adverse effects, both at the peripheral (i.e. decrease in secretions or constipation) and the central level (risk of falls and fractures or cognitive impairment), the latter usually tending to have a greater impact on the geriatric population . These effects might result in an increase in hospital admissions related to these complications, but they also imply an increase in the length of hospital stays and even death …”

“…decrease in secretions or constipation) and the central level (risk of falls and fractures or cognitive impairment), the latter usually tending to have a greater impact on the geriatric population. [1][2][3] These effects might result in an increase in hospital admissions related to these complications, 4 but they also imply an increase in the length of hospital stays and even death. 5 There is currently no standardization for the measurement of the anticholinergic burden, and there are many different ways to measure this activity.…”