Cognitive decline in older persons initiating anticholinergic medications

Abstract

Background: This study examines the effect of initiating medications with anticholinergic activity on the cognitive functions of older persons.

Methods: Participants were 896 older community-dwelling, Catholic clergy without baseline dementia. Medication data was collected annually. The Anticholinergic Cognitive Burden Scale was utilized to identify use of a medication with probable or definite anticholinergic activity. Participants had at least two annual cognitive evaluations.

Results: Over a mean follow-up of 10 years, the annual rate of global cognitive function decline for never users, prevalent users, and incident users was -0.062 (SE = 0.005), -0.081(SE = 0.011), and -0.096 (SE = 0.007) z-score units/year, respectively. Compared to never users, incident users had a more rapid decline (difference = -0.034 z-score units/year, SE = 0.008, p<0.001) while prevalent users did not have a significantly more rapid decline (p = 0.1).

Conclusions: Older persons initiating a medication with anticholinergic activity have a steeper annual decline in cognitive functioning than those who are not taking these medications.

Figure 1. Estimated global cognitive performance (z-score units) as a function of time in study.

Figure 1A shows results from a mixed-effects model without a change point added for initiation of a medication with anticholinergic activity and Figure 1B shows results from a model with a change point. The blue line shows average global cognitive performance over time for a typical person (75-year-old female with 18 years of education) who never used an anticholinergic medication. The green line shows average cognitive function over time for a typical person who was taking a medication with anticholinergic activity at baseline. The black line shows average global cognitive function over time for a typical person who first started anticholinergic medication after 4.5 years.