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Anticholinergic medication burden and cognitive function in participants of the ASPREE study
Author(s) -
Broder Jonathan C.,
Ryan Joanne,
Shah Raj C.,
Lockery Jessica E.,
Orchard Suzanne G.,
GilmartinThomas Julia F.M.,
Fravel Michelle A.,
Owen Alice J.,
Woods Robyn L.,
Wolfe Rory,
Storey Elsdon,
Murray Anne M.,
Ernst Michael E.
Publication year - 2022
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.2652
Subject(s) - anticholinergic , medicine , dementia , cognition , verbal learning , cognitive decline , geriatric depression scale , trail making test , gerontology , clinical psychology , psychiatry , disease , cognitive impairment , depressive symptoms
Study Objective What is the association between anticholinergic burden and specific domains of cognitive function in older adults who are initially without major cognitive impairment? Design Post‐hoc analysis of longitudinal observational data from the ASPirin in Reducing Events in the Elderly (ASPREE) study. Patients 19,114 participants from Australia and the United States aged 70 years and older (65 years and older for US minorities) were recruited and followed for a median of 4.7 years. At enrollment, participants were free of known cardiovascular disease, major physical disability, or dementia. Measurements Cognitive assessments administered at baseline and biennially at follow‐up visits included the Modified Mini‐Mental State examination (3MS), Hopkins Verbal Learning Test–Revised (HVLT‐R) delayed recall, Controlled Oral Word Association Test (COWAT), and Symbol Digit Modalities Test (SDMT). Anticholinergic burden was calculated at baseline using the Anticholinergic Cognitive Burden (ACB) scale and grouped as scores of 0 (no burden), 1‐2 (low to moderate), or 3+ (high). Main Results Linear mixed effects models were used to assess the relationship between ACB score and cognition over time. After adjusting for sex, age, education, minority status, smoking status, hypertension, diabetes, depression, chronic kidney disease, country, and frailty, participants with a high ACB score had worse performance over time for 3MS (Adjusted [Adj] B=‐0.092, P=0.034), HVLT‐R delayed recall (Adj B=‐0.104, P<0.001), COWAT (Adj B=‐0.151, P<0.001), and SDMT (Adj B=‐0.129, P=0.026), than participants with an ACB score of 0. A low to moderate ACB score was also associated with worse performance over time for HVLT‐R delayed recall (Adj B=‐0.037, P=0.007) and COWAT (Adj B=‐0.065, P=0.003), compared to those with no ACB. Conclusions Anticholinergic burden predicts worse cognitive function over time in initially dementia‐free older adults, particularly for executive function (COWAT) and episodic memory (HVLT‐R).