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. 2024 Jul 23;16(1):163.
doi: 10.1186/s13195-024-01530-8.

Impact of cumulative exposure to anticholinergic and sedative drugs on cognition in older adults: a memory clinic cohort study

Elsa Reallon  1 , Frédéric Gervais  2 , Claire Moutet  3 , Virginie Dauphinot  3 , Pauline Desnavailles  3 , Teddy Novais  2   4 , Pierre Krolak-Salmon  3   5 , Antoine Garnier-Crussard  3   6 , Christelle Mouchoux  2 ; MEMORA group
Collaborators, Affiliations

Impact of cumulative exposure to anticholinergic and sedative drugs on cognition in older adults: a memory clinic cohort study

Elsa Reallon et al. Alzheimers Res Ther. .

Erratum in

Abstract

Background: Long-term exposure to anticholinergic and sedative drugs could be a modifiable risk factor for cognitive decline. The objective of this study was to measure the association between previous cumulative anticholinergic and sedative drug exposure (Drug Burden Index) and cognitive decline.

Methods: A cohort study (MEMORA cohort) was conducted in a French memory clinic for patients attending a consultation between November 2014 and December 2020, with at least 2 Mini-Mental State Examination (MMSE) measurements (≥ 6 months apart) and available medication data from the local Primary Health Insurance Fund database (n = 1,970). Drug Burden Index was linearly cumulated until each MMSE measurement and was used to categorise patients according to their level of exposure (no exposure, moderate, or high). The longitudinal association between Drug Burden Index and MMSE was assessed using a multivariate linear mixed model, adjusted for age, education level, anxiety disorders, depressive disorders, functional autonomy, and behavioural disorders.

Results: Overall, 1,970 patients were included with a mean follow-up duration of 2.78 years (± 1.54) and 2.99 visits per patients (5,900 MMSE + Drug Burden Index measurements collected). At baseline, 68.0% of patients had moderate cumulative anticholinergic and sedative drug exposure and a mean MMSE of 21.1. MMSE decrease was steeper in patients with moderate and high Drug Burden Index ( -1.74 and -1.70/year, respectively) than in patients with no exposure (-1.26/year) after adjusting for age, education, anxiety and depressive disorders, functional autonomy, and behavioural disorders (p < 0.01).

Conclusions: Long-term exposure to anticholinergic and sedative drugs is associated with steeper cognitive decline. Medication review focusing on de-prescribing these drugs could be implemented early to reduce cognitive impairment.

Keywords: Alzheimer’s Disease; Anticholinergic; Dementia; Hypnotics and Sedatives; Potentially Inappropriate Medication.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Timeline description of the study. DBI: Drug Burden Index; MMSE: Mini-Mental State Examination; PHIF: Primary Health Insurance Fund
Fig. 2
Fig. 2
Inclusion flow-chart. MMSE: Mini-Mental State Examination; PHIF: Primary Health Insurance Fund
See this image and copyright information in PMC

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