Volume 59, Issue 8 p. 1477-1483

Anticholinergic Medication Use and Cognitive Impairment in the Older Population: The Medical Research Council Cognitive Function and Ageing Study

Chris Fox MD

Chris Fox MD

From the Department of Psychiatry, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, United Kingdom

*Joint first authors.

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Kathryn Richardson MSc

Kathryn Richardson MSc

Institute of Public Health

*Joint first authors.

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Ian D. Maidment MA

Ian D. Maidment MA

Kent and Medway National Health Service and Social Care Partnership Trust, Kent, United Kingdom

Centre for Health Service Studies, University of Kent, Kent, United Kingdom

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George M. Savva PhD

George M. Savva PhD

Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom

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Fiona E. Matthews PhD

Fiona E. Matthews PhD

Medical Research Council Biostatistics Unit, Cambridge, United Kingdom

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David Smithard MD

David Smithard MD

Kent Community Health National Health Services Trust, Ashford, United Kingdom

National Institute for Health Research, Maidstone, United Kingdom

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Simon Coulton MSc

Simon Coulton MSc

Centre for Health Service Studies, University of Kent, Kent, United Kingdom

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Cornelius Katona MD

Cornelius Katona MD

University College London, London, United Kingdom

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Malaz A. Boustani MD, MPH

Malaz A. Boustani MD, MPH

Center for Aging Research

Department of Medicine

School of Medicine, Indiana University, Indianapolis, Indiana

Regenstrief Institute Inc., Indianapolis, Indiana.

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Carol Brayne MD

Carol Brayne MD

Institute of Public Health

Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom

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First published: 24 June 2011
Citations: 431
Address correspondence to Dr. Chris Fox, Clinical Senior Lecturer Psychiatry/Hon Consultant Psychiatrist, School of Medicine, Health Policy and Practice, DeNDRoN Eastern Research Director and Dementia Research Group Chair, University of East Anglia, Norwich, NR4 7TJ, UK. E-mail: [email protected]

Abstract

OBJECTIVES: To determine whether the use of medications with possible and definite anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative.

DESIGN: A 2-year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993.

SETTING: Community-dwelling and institutionalized participants.

PARTICIPANTS: Thirteen thousand four participants aged 65 and older.

MEASUREMENTS: Baseline use of possible or definite anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years.

RESULTS: At baseline, 47% of the population used a medication with possible anticholinergic properties, and 4% used a drug with definite anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonanticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI)=0.03–0.64, P=.03) than not taking anticholinergics, whereas the use of possible anticholinergics at baseline was not associated with further decline (0.02, 95% CI=−0.14–0.11, P=.79). Two-year mortality was greater for those taking definite (OR=1.68; 95% CI=1.30–2.16; P<.001) and possible (OR=1.56; 95% CI=1.36–1.79; P<.001) anticholinergics.

CONCLUSION: The use of medications with anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.