Anticholinergic medication use and cognitive impairment in the older population: the Medical Research Council cognitive function and ageing study

Chris Fox, Kathryn Richardson, Ian D. Maidment, George M. Savva, Fiona E. Matthews, David G. Smithard, Simon Coulton, Cornelius Katona, Malaz A. Boustani, Carol Brayne

Research output: Contribution to journalArticle

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.
LanguageEnglish
Pages1477-1483
Number of pages7
JournalJournal of the American Geriatrics Society
Volume59
Issue number8
Early online date24 Jun 2011
DOIs
Publication statusPublished - Aug 2011

Fingerprint

Cholinergic Antagonists
Cognition
Biomedical Research
Population
Confidence Intervals
Mortality
Cognitive Aging
Cognitive Dysfunction
Independent Living
varespladib methyl
Social Class
Longitudinal Studies
Outcome Assessment (Health Care)
Health

Keywords

  • aged
  • 80 and over
  • cholinergic antagonists
  • cognition disorders
  • comorbidity
  • England
  • female
  • geriatric assessment
  • health surveys
  • humans
  • longitudinal studies
  • male
  • mental status schedule
  • odds ratio
  • prospective studies
  • psychometrics
  • risk factors
  • Wales
  • anticholinergic activity
  • cognitive impairment
  • elderly

Cite this

Fox, Chris ; Richardson, Kathryn ; Maidment, Ian D. ; Savva, George M. ; Matthews, Fiona E. ; Smithard, David G. ; Coulton, Simon ; Katona, Cornelius ; Boustani, Malaz A. ; Brayne, Carol. / Anticholinergic medication use and cognitive impairment in the older population : the Medical Research Council cognitive function and ageing study. In: Journal of the American Geriatrics Society. 2011 ; Vol. 59, No. 8. pp. 1477-1483.
@article{c3e3669053a14d64a47645393e08c5d0,
title = "Anticholinergic medication use and cognitive impairment in the older population: the Medical Research Council cognitive function and ageing study",
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.",
keywords = "aged, 80 and over, cholinergic antagonists, cognition disorders, comorbidity, England, female, geriatric assessment, health surveys, humans, longitudinal studies, male, mental status schedule, odds ratio, prospective studies, psychometrics, risk factors, Wales, anticholinergic activity, cognitive impairment, elderly",
author = "Chris Fox and Kathryn Richardson and Maidment, {Ian D.} and Savva, {George M.} and Matthews, {Fiona E.} and Smithard, {David G.} and Simon Coulton and Cornelius Katona and Boustani, {Malaz A.} and Carol Brayne",
note = "{\circledC} 2011, Copyright the Authors. Journal compilation {\circledC} 2011, The American Geriatrics Society.",
year = "2011",
month = "8",
doi = "10.1111/j.1532-5415.2011.03491.x",
language = "English",
volume = "59",
pages = "1477--1483",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "8",

}

Anticholinergic medication use and cognitive impairment in the older population : the Medical Research Council cognitive function and ageing study. / Fox, Chris; Richardson, Kathryn; Maidment, Ian D.; Savva, George M.; Matthews, Fiona E.; Smithard, David G.; Coulton, Simon; Katona, Cornelius; Boustani, Malaz A.; Brayne, Carol.

In: Journal of the American Geriatrics Society, Vol. 59, No. 8, 08.2011, p. 1477-1483.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Anticholinergic medication use and cognitive impairment in the older population

T2 - Journal of the American Geriatrics Society

AU - Fox, Chris

AU - Richardson, Kathryn

AU - Maidment, Ian D.

AU - Savva, George M.

AU - Matthews, Fiona E.

AU - Smithard, David G.

AU - Coulton, Simon

AU - Katona, Cornelius

AU - Boustani, Malaz A.

AU - Brayne, Carol

N1 - © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

PY - 2011/8

Y1 - 2011/8

N2 - 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.

AB - 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.

KW - aged

KW - 80 and over

KW - cholinergic antagonists

KW - cognition disorders

KW - comorbidity

KW - England

KW - female

KW - geriatric assessment

KW - health surveys

KW - humans

KW - longitudinal studies

KW - male

KW - mental status schedule

KW - odds ratio

KW - prospective studies

KW - psychometrics

KW - risk factors

KW - Wales

KW - anticholinergic activity

KW - cognitive impairment

KW - elderly

UR - http://www.scopus.com/inward/record.url?scp=79960941923&partnerID=8YFLogxK

UR - http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2011.03491.x/abstract

U2 - 10.1111/j.1532-5415.2011.03491.x

DO - 10.1111/j.1532-5415.2011.03491.x

M3 - Article

VL - 59

SP - 1477

EP - 1483

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 8

ER -