Study links medications with anticholinergic activity to cognitive decline

Medications with anticholinergic activity increase the cumulative risk of cognitive impairment and death, according to findings from a study published online June 24 in the Journal of the American Geriatric Society.

The authors examined data from an ongoing observational study (Medical Research Council Cognitive Function and Ageing Study; MRC CFAS) to determine whether the use of these medications increased the risk of cognitive impairment and death in older people and whether there was a cumulative effect.

“Identifying risk factors for cognitive decline may lead researchers to a better understanding of clinical interventions to reduce the risk of developing Alzheimer’s disease,” the authors wrote. The use of anticholinergic medications has been associated with acute cognitive impairment in previous studies, the authors added. And these medications are used to treat a wide variety of conditions, many of which affect elderly patients, such as hypertension and congestive heart disease. However few studies have evaluated long-term exposure as a modifiable risk factor for cognitive decline, the authors said.

The study included 13,004 men and women aged 65 and older. Researchers found that 47% of participants reported taking medications with anticholinergic properties. The use of medication with definite anticholinergic effects was associated with a 0.33-point greater decline in Mini-Mental State Examination (MMSE) score (95% CI, 0.03–0.64; P=.03) than not taking anticholinergics. The use of possible anticholinergics at baseline was not associated with further decline (0.02, 95% CI, –0.14–0.11; P =.79). In addition, 2-year mortality was greater for those taking definite and possible anticholinergics. The researchers noted that as far as they knew, they may be the first to identify a link between mortality and anticholinergic burden, but due to the number and kinds of diseases these medications are used to treat, this finding should be viewed cautiously.

Clinicians should review cumulative anticholinergic burden in people presenting with cognitive impairment, the researchers noted.

“With a growing prevalence of cognitive impairment in the older adult population, prescribers should be aware of the potential effect that anticholinergics have on the development of cognitive and executive dysfunction and mortality,” the authors concluded.