Risk of cognitive decline with use of anticholinergics among elderly
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Risk of cognitive decline with use of anticholinergics among elderly Use of anticholinergic medications is associated with an increased risk of progression to mild cognitive impairment (MCI) and accelerated cognitive decline in older adults, particularly in those with risk factors for Alzheimer’s disease (AD). These are the main findings of a US study that investigated the effect of use of anticholinergic medications on progression to MCI over a 10-year period as well as 3-year rates of decline in memory, language and attention/ executive function in a sample of 688 participants (mean age 73.5 years) with normal cognition at baseline. Interactions with AD risk factors (APOE ε4 genotype and cerebrospinal fluid [CSF] biomarkers) were also assessed. The data analysis showed that 230 participants (33%) used at least one anticholinergic over the study period, most commonly metoprolol, atenolol, loratadine and bupropion. The majority of medications were taken at levels much higher than the minimum effective dose for a geriatric population. Cox regression models showed that users of anticholinergic medications, compared to non-users, had a significantly increased risk of progression to MCI across 10 years (hazard ratio [HR] 1.47; 95% CI 1.10–1.98). Furthermore, the risk of progression to MCI was exacerbated among those with AD risk factors, particularly with CSF biomarkers (HR 4.89; 95% CI 2.86–8.36) and also among those who were APOE ε4-positive (HR 2.69; 95% CI 1.78–4.07). Use of anticholinergics was also associated with decline in memory and language, similarly exacerbated in the presence of AD risk factors. Weigand AJ, et al. Association of anticholinergic medication and AD biomarkers with incidence of MCI among cognitively normal older adults. Neurology : 2 Sep 2020. 803501990 Available from: URL: https://doi.org/10.1212/WNL.0000000000010643
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Reactions 19 Sep 2020 No. 1822
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