Potentially inappropriate anticholinergic medication use interacts with memory‐enhancing treatment for patients with Alzheimer’s disease or related dementias

Abstract

Background Anticholinergic medications have been consistently linked to cognitive impairment or decline, resulting in their classification as potentially inappropriate medications for older adults according to the Beers Criteria. Despite their potential for adverse effects, these medications continue to be used for individuals regardless of their cognitive status and concurrent medications. Here, we investigated risk factors for anticholinergic medication use in populations with and without Alzheimer’s disease or related dementias (ADRD). For patients with ADRD, we also investigated whether anticholinergic use may be interacting with memory‐enhancing medication therapy. Methods We conducted a cross‐sectional study using nationally representative data from the 2016 National Ambulatory Medical Care Survey. We included non‐perioperative office‐based visits for patients ≥ 65 years old. Visit characteristics were compared between those with and without ADRD using descriptive statistics; adjusted logistic regression was used to identify predictors of anticholinergic use. Results Of 218,182,131 outpatient visits, 2.2% were for patients with ADRD (N=4,651,563). 20.5% of visits for patients with ADRD reported an anticholinergic, compared to 8.1% of visits for patients without ADRD. The most common anticholinergics reported for ADRD visits were cyclobenzaprine (25.3%), benztropine (12.8%), and meclizine (12.2%). Significant predictors of anticholinergic report (aOR [95% CI]) were ADRD status (3.1 [1.2‐8.3]), female sex (2.1 [1.4‐3.1]), new problem as primary visit reason (1.8 [1.2‐2.7]), former tobacco use (1.7 [1.1‐2.7]), and polypharmacy (11.6 [6.9‐19.7]), respectively). Of the 1,633,358 visits for patients with ADRD that reported use of a cholinesterase inhibitor, 29.3% also reported an anticholinergic, which combination may negate any cognitive benefits the cholinesterase inhibitor may have been able to impart. Conclusion In a nationally representative sample, anticholinergic use was reported in approximately one‐fifth of visits for patients with ADRD. After adjusting for potential confounders, ADRD was an independent risk factor for report of an anticholinergic. Of those visits for ADRD patients whose cognitive impairment was being treated with a cholinesterase inhibitor, almost one‐third reported a drug‐drug interaction with an anticholinergic that may have detrimental results on cognition. Future work should investigate points of intervention to reduce anticholinergic use and inappropriate drug interactions in this population.