TY - JOUR
T1 - Anticholinergic medication burden and cognitive function in participants of the ASPREE study
AU - Broder, Jonathan C.
AU - Ryan, Joanne
AU - Shah, Raj C.
AU - Lockery, Jessica E.
AU - Orchard, Suzanne G.
AU - Gilmartin-Thomas, Julia F.M.
AU - Fravel, Michelle A.
AU - Owen, Alice J.
AU - Woods, Robyn L.
AU - Wolfe, Rory
AU - Storey, Elsdon
AU - Murray, Anne M.
AU - Ernst, Michael E.
N1 - Funding Information:
The ASPREE study was supported by grants (U01AG029824 and U19AG062682) from the National Institute on Aging and the National Cancer Institute at the National Institutes of Health, by grants (334047 and 1127060) from the National Health and Medical Research Council of Australia, and by Monash University and the Victorian Cancer Agency.
Funding Information:
Dr. Shah reports grants from National Institute on Aging, grants from Illinois Department of Public Health, during the conduct of the study; other from Alzheimer's Assocation—Illinois Chapter, other from Eli Lilly & Co., Inc., other from Genentech, Inc., other from Lundbeck, Inc., other from Merck & Co, Inc., other from Navidea Biopharmaceuticals, other from Novartis Pharmaceuticals, Inc., other from Takeda Development Center Americas, Inc., grants from NIH, grants from PCORI, grants from DOD, other from Amylyx Pharmaceuticals, Inc., other from Roche Holdings AG, other from Athira Pharma Inc., outside the submitted work.
Publisher Copyright:
© 2021 Pharmacotherapy Publications, Inc.
PY - 2022/2
Y1 - 2022/2
N2 - Study Objective: What is the association between anticholinergic burden and specific domains of cognitive function in older adults who are initially without major cognitive impairment?. Design: Post-hoc analysis of longitudinal observational data from the ASPirin in Reducing Events in the Elderly (ASPREE) study. Patients: 19,114 participants from Australia and the United States aged 70 years and older (65 years and older for US minorities) were recruited and followed for a median of 4.7 years. At enrollment, participants were free of known cardiovascular disease, major physical disability, or dementia. Measurements: Cognitive assessments administered at baseline and biennially at follow-up visits included the Modified Mini-Mental State examination (3MS), Hopkins Verbal Learning Test–Revised (HVLT-R) delayed recall, Controlled Oral Word Association Test (COWAT), and Symbol Digit Modalities Test (SDMT). Anticholinergic burden was calculated at baseline using the Anticholinergic Cognitive Burden (ACB) scale and grouped as scores of 0 (no burden), 1-2 (low to moderate), or 3+ (high). Main Results: Linear mixed effects models were used to assess the relationship between ACB score and cognition over time. After adjusting for sex, age, education, minority status, smoking status, hypertension, diabetes, depression, chronic kidney disease, country, and frailty, participants with a high ACB score had worse performance over time for 3MS (Adjusted [Adj] B=-0.092, P=0.034), HVLT-R delayed recall (Adj B=-0.104, P<0.001), COWAT (Adj B=-0.151, P<0.001), and SDMT (Adj B=-0.129, P=0.026), than participants with an ACB score of 0. A low to moderate ACB score was also associated with worse performance over time for HVLT-R delayed recall (Adj B=-0.037, P=0.007) and COWAT (Adj B=-0.065, P=0.003), compared to those with no ACB. Conclusions: Anticholinergic burden predicts worse cognitive function over time in initially dementia-free older adults, particularly for executive function (COWAT) and episodic memory (HVLT-R).
AB - Study Objective: What is the association between anticholinergic burden and specific domains of cognitive function in older adults who are initially without major cognitive impairment?. Design: Post-hoc analysis of longitudinal observational data from the ASPirin in Reducing Events in the Elderly (ASPREE) study. Patients: 19,114 participants from Australia and the United States aged 70 years and older (65 years and older for US minorities) were recruited and followed for a median of 4.7 years. At enrollment, participants were free of known cardiovascular disease, major physical disability, or dementia. Measurements: Cognitive assessments administered at baseline and biennially at follow-up visits included the Modified Mini-Mental State examination (3MS), Hopkins Verbal Learning Test–Revised (HVLT-R) delayed recall, Controlled Oral Word Association Test (COWAT), and Symbol Digit Modalities Test (SDMT). Anticholinergic burden was calculated at baseline using the Anticholinergic Cognitive Burden (ACB) scale and grouped as scores of 0 (no burden), 1-2 (low to moderate), or 3+ (high). Main Results: Linear mixed effects models were used to assess the relationship between ACB score and cognition over time. After adjusting for sex, age, education, minority status, smoking status, hypertension, diabetes, depression, chronic kidney disease, country, and frailty, participants with a high ACB score had worse performance over time for 3MS (Adjusted [Adj] B=-0.092, P=0.034), HVLT-R delayed recall (Adj B=-0.104, P<0.001), COWAT (Adj B=-0.151, P<0.001), and SDMT (Adj B=-0.129, P=0.026), than participants with an ACB score of 0. A low to moderate ACB score was also associated with worse performance over time for HVLT-R delayed recall (Adj B=-0.037, P=0.007) and COWAT (Adj B=-0.065, P=0.003), compared to those with no ACB. Conclusions: Anticholinergic burden predicts worse cognitive function over time in initially dementia-free older adults, particularly for executive function (COWAT) and episodic memory (HVLT-R).
KW - Anticholinergic Cognitive Burden
KW - anticholinergic medications
KW - dementia
KW - episodic memory
KW - executive function
KW - global cognition
KW - processing speed
UR - http://www.scopus.com/inward/record.url?scp=85121145709&partnerID=8YFLogxK
U2 - 10.1002/phar.2652
DO - 10.1002/phar.2652
M3 - Article
C2 - 34866212
AN - SCOPUS:85121145709
SN - 0277-0008
VL - 42
SP - 134
EP - 144
JO - Pharmacotherapy
JF - Pharmacotherapy
IS - 2
ER -