Anticholinergics Exposure and the Risk of Cognitive Decline

BACKGROUND: The role of modifiable risk factors for patients with dementia and at risk of dementia requires investigation with large population studies. OBJECTIVES: To examine the association between anticholinergic medication use and cognitive decline in the older population DESIGN: A two-year longitudinal study of participants enrolled in the Medical Research Council (MRC) Cognitive Function and Ageing Study (CFAS) between 1991 and 1993. SETTING: Community and institionalized participants. PARTICIPANTS: A sample of 13,004 participants aged 65 years and older. MEASUREMENTS: Baseline use of possible or definite anticholinergics as determined by the Anticholinergic Cognitive Burden (ACB) scale, and cognition as determined by the Mini-Mental State Examination (MMSE). The main outcome measure was decline on the mini-mental state examination 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 non-anticholinergic medications, number of co-morbid health conditions and cognitive performance at baseline, the use of medication with definite anticholinergic effects was associated with an additional reduction in MMSE score of 0.43 points (95% CI 0.11, 0.75; p<0.008) compared to those not taking anticholinergics, whereas the use of possible anticholinergics at baseline was not associated with further MMSE decline (estimate=0.00 95% CI -0.11, 0.11; p=0.98). Two year mortality was increased both for those taking definite anticholinergic medications (OR 1.68; 95% CI 1.30, 2.16; p<0.001) and for those taking possible anticholinergic medications (OR 1.56; 95% CI: 1.36, 1.79; p