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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
Author(s) -
Andre Laurine,
Gallini Adeline,
Montastruc François,
Coley Nicola,
Montastruc JeanLouis,
Vellas Bruno,
Andrieu Sandrine,
Gardette Virginie
Publication year - 2019
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.13734
Subject(s) - anticholinergic , cognitive decline , cognition , hazard ratio , digit symbol substitution test , medicine , psychology , psychiatry , confidence interval , dementia , disease , placebo , alternative medicine , pathology
Aim The aim of the present study was to assess the association between anticholinergic (atropinic) burden and cognitive decline in older adults over the course of 3 years. Methods We used data from Multidomain Alzheimer Preventive Trial (MAPT) study participants aged ≥70 years and at risk of cognitive decline. Cognitive function was assessed with a composite score [Mini‐Mental State Examination (MMSE) orientation, Free and Cued Selective Reminding Test, Category Naming Test, Digit Symbol Substitution Test] at 12, 24 and 36 months. Participants declining by more than 0.236 points on the composite score (representing the lowest quintile of 1‐year cognitive change) during any 1‐year period were considered to have undergone cognitive decline. Anticholinergic exposure was defined by four methods for each of four anticholinergic scales (Anticholinergic Drug Scale, Anticholinergic Cognitive Burden, Anticholinergic Risk Scale, the Durán list). The association between cognitive decline and time‐varying anticholinergic exposure [primary analysis using the Durán list and maximal anticholinergic score (0, 1 or 3)] was assessed using Cox proportional hazards models. Other cognitive decline definitions were used in sensitivity analyses. Results At baseline, among 1396 patients included, 7.4–23.5% were exposed to anticholinergic agents, depending on the anticholinergic scale used. Sixty‐four per cent of participants experienced cognitive decline during follow‐up. Regardless of the anticholinergic scale/exposure measurement used, no significant association was observed with cognitive decline {primary analysis: compared with non‐anticholinergic agent users, hazard ratio [HR] = 1.14 [95% confidence interval (CI) = 0.95, 1.38] for anticholinergic score = 1; HR = 0.92 [95% CI = 0.65, 1.30] for score = 3}. Results were stable in sensitivity analyses. Conclusion We found no significant association between anticholinergic exposure and cognitive decline in older adults using anticholinergic scales and definitions of exposure.