Chronic Anticholinergic Use and the Aging Brain

Background—Older Americans are facing an epidemic of chronic diseases and are thus exposed to anticholinergics (AC) that might negatively affect their risk of developing mild cognitive impairment (MCI) or dementia. Objective—Investigate the association between impairment in cognitive function and previous AC exposure. Design—A retrospective cohort study. Setting—Primary care clinics in Indianapolis, Indiana. Participants—3690 older adults who have undergone cognitive assessment and had a one-year medication dispensing record. Outcome—Cognitive function was measured in two sequential steps; a two-step screening process followed by a formal diagnostic process for participants with positive screening results. Exposure—Three patterns of AC exposure were defined by the duration of AC exposure, the number of AC medications dispensed at the same time, and the severity of AC effects as determined by the Anticholinergic Cognitive Burden List. Results—In comparison to older adults with no anticholinergic exposure and after adjusting for age, race, gender, and underlying comorbidity, the odds ratio (OR) for having a diagnosis of MCI was 2.73 (95% confidence interval, CI; 1.27, 5.87) among older adults who were exposed to at least three possible anticholinergic for at least 90 days; and the OR for having dementia was 0.43 (95% CI; 0.10, 1.81). Conclusion—Exposure to medications with severe anticholinergic cognitive burden may be a risk factor for developing MCI. © 2012 Elsevier Inc. All rights reserved. Corresponding Author: Malaz Boustani, MD, MPH, Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, Indiana 46202-3012, Phone: 317-423-5633, Fax: 317-423-5695, mboustan@iupui.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author Manuscript Alzheimers Dement. Author manuscript; available in PMC 2014 July 01. Published in final edited form as: Alzheimers Dement. 2013 July ; 9(4): 377–385. doi:10.1016/j.jalz.2012.02.005. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript