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Role of anticholinergic burden in primary care patients with first cognitive complaints
Author(s) -
Grande G.,
Tramacere I.,
Vetrano D. L.,
Clerici F.,
Pomati S.,
Mariani C.,
Filippini G.
Publication year - 2017
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13313
Subject(s) - anticholinergic , medicine , confidence interval , cognition , confounding , anticholinergic agents , multivariate analysis , physical therapy , psychiatry , pediatrics
Background and purpose Drugs with anticholinergic properties might have a negative impact on cognition, but findings are still conflicting. The association was evaluated between anticholinergic drugs and cognitive performance in primary care patients with first cognitive complaints. Methods From April 2013 to March 2014, 353 general practitioners administered the Mini‐Mental State Examination ( MMSE ) to patients presenting with first cognitive complaints. Drug history was collected and the anticholinergic cognitive burden ( ACB ) was scored and categorized as ACB 0, ACB 1 and ACB 2+. A mixed effect linear regression model was used to assess the association between ACB and MMSE score. Results Of 4249 subjects entering the study (mean age 77 ± 8.2 years, 66.4% women and mean years of schooling 8.9 ± 4.5), 25.8% received at least one drug with anticholinergic action. According to multivariate analysis, and after adjustment for several confounders, subjects with ACB 2+ had a statistically significant lower MMSE score compared with those with ACB 0 ( β −0.63; 95% confidence interval −1.19; −0.07). Subjects with ACB 1 had a non‐statistically significant lower MMSE score than those with ACB 0 ( β −0.11; 95% confidence interval −0.37; 0.15). Conclusions Anticholinergic medication might affect cognitive function in people with first cognitive complaints. Alternatives should be taken into account when possible, balancing the benefits and harms of these medications.