P4‐284: Current Anticholinergic Medication Use And Cognitive Impairment In The Older Population: The Medical Research Council Cognitive Function and Ageing Study
Year: 2009
Type: article
Study design: Observational Study
Abstract: The cholinergic system has been implicated in cognitive impairment and is the target of Cholinesterase inhibitors, the primary pharmacotherapeutic treatment for Alzheimer's disease. Cholinergic neurons degenerate with age hence the elderly are more susceptible to cognitive effects of anticholinergics. Anticholinergic medication use has been negatively associated with cognition in clinical settings and we sought to examine this in a population-based study. The anticholinergic burden scale which we have developed and validated previously was utilised to code medications reported at baseline in the Medical Research Council Cognitive Function and Ageing Study (MRC-CFAS). These were scored as 0 (none), 1 (mild), 2 (moderate), or 3 (severe) according to their anticholinergic activity. Any discordance was resolved by discussion until a consensus was obtained. Scores were summed for each participant to give a total Anticholinergic Cognitive Burden (ACB) score. Incidence rate ratios for errors in the Mini-Mental State Examination (MMSE) associated with categories of ACB score (0, 1, 2, 3, 4 or 5+) were calculated using negative binomial regression both unadjusted and adjusted for age, sex, education, social class, number of self-reported comorbidities, and number of other medications. Of the 11,994 participants, 59% were female and the mean (SD) age was 75 (6.7) years. 26,759 prescription and over-the-counter medications were reported by 9,530 participants and 47% of participants reported taking medications with anticholinergic effects. A statistically significant dose-response relation was observed between increasing ACB score and decreasing MMSE, e.g. those with an ACB score of 5 or greater were associated with making 21% (95%CI 8%-35%) more errors on the MMSE than those not taking anticholinergics. However, the relationship with cognitive impairment was only seen for ACB conferred by Central Nervous System (CNS) medications, in particular antipsychotics. The ACB of non-CNS medications were not significantly associated with MMSE. Anticholinergic medication use in the older population was common. An inverse relation existed between the anticholinergic burden of current medication use and cognition, but the association was driven by the ACB of CNS medications. Longitudinal analyses in population-based studies are required to further examine the direction of causality.
Source: Alzheimer s & Dementia
Institutions: University of Cambridge, University of Kent, Kent and Medway NHS and Social Care Partnership Trust, East Kent Hospitals University NHS Foundation Trust, University College London, Camden and Islington NHS Foundation Trust, Indiana University Indianapolis, MRC Biostatistics Unit, Medical Research Council
Language: English
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2019484466