Drug Burden Index and change in cognition over time in community-dwelling older men: the CHAMP study

Kris M Jamsen, Danijela Gnjidic, Sarah N Hilmer, Jenni Ilomaki, David G Le Couteur, Fiona M Blyth, David J Handelsman, Vasi Naganathan, Louise M Waite, Robert G Cumming, J Simon Bell

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Objective: Anticholinergic and sedative medications are associated with acute cognitive impairment,but the long-term impact on change in cognition is unclear. This study investigated theeffect of anticholinergic and sedative medications, quantified using the Drug Burden Index (DBI),on change in cognition over time in community-dwelling older men.
Methods: This was a prospective cohort study of men aged ≥70 years in Sydney, Australia. DBI was assessed at baseline, 2, and 5 years. Cognitive performance was assessed using the Mini-Mental State Exam (MMSE) at each wave. Logistic quantile mixed-effects modelling was used to assess the adjusted effect of DBI on the median MMSE-time profile. Analyses were restricted to men with English-speaking backgrounds (n=1059, 862, and 611 at baseline, 2, and 5 years).
Results: Overall, 292 (27.7%), 258 (29.9%), and 189 (31.3%) men used anticholinergic or sedative medications at baseline, 2, and 5 years. There was a concave relationship between MMSE and time, where higher DBI corresponded to lower MMSE scores (coefficient: -0.161; 95% CI: -0.250 to -0.071) but not acceleration of declining MMSE over time.
Conclusions: Exposure to anticholinergic and sedative medications is associated with a small impairment in cognitive performance but not decline in cognition over time.
Original languageEnglish
Pages (from-to)157–164
Number of pages8
JournalAnnals of Medicine
Issue number2
Publication statusPublished - 2017


  • Hypnotics and sedatives
  • cholinergic antagonists
  • cognition disorders
  • aged
  • cohort studies
  • Australia

Cite this

Jamsen, K. M., Gnjidic, D., Hilmer, S. N., Ilomaki, J., Le Couteur, D. G., Blyth, F. M., Handelsman, D. J., Naganathan, V., Waite, L. M., Cumming, R. G., & Bell, J. S. (2017). Drug Burden Index and change in cognition over time in community-dwelling older men: the CHAMP study. Annals of Medicine, 49(2), 157–164. https://doi.org/10.1080/07853890.2016.1252053