Association between anticholinergic drugs and apolipoprotein E epsilon4 allele and poorer cognitive function in older cardiovascular patients: a cross-sectional study.
OBJECTIVE
To clarify the association between anticholinergic drugs and apolipoprotein E epsilon4 allele carrier status (APOE4) and cognitive dysfunction.


METHODS
Cross-sectional analyses of current drug use and cognitive functioning according to the baseline assessments of the Drugs and Evidence-Based Medicine in the Elderly Study.


METHODS
Helsinki, Finland.


METHODS
Four hundred community-dwelling people aged 75 to 90 without clinical dementia but with a history of stable atherosclerotic disease.


METHODS
Cognitive function according to the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Scale (CDR). Participants' use of anticholinergic drugs was estimated using definitions from previous scientific literature. APOE alleles determined from peripheral blood leukocyte deoxyribonucleic acid using standard polymerase chain reaction-based methods.


RESULTS
There was an association between anticholinergic drugs and lower MMSE scores (P for trend <.001). The higher the number of anticholinergic drugs, the lower the MMSE score. Subjects with the APOE4 allele and using drugs with anticholinergic properties had the lowest median MMSE score (26), whereas those without the APOE4 allele and not using drugs with anticholinergic properties had the highest median MMSE score (28). When adjusted for age, sex, and education, the difference between the groups remained significant. The finding was similar for CDR scores.


CONCLUSIONS
Use of drugs with anticholinergic properties was associated with lower cognitive function irrespective of APOE4 carrier status. Having lower cognitive function as a group, APOE4 carriers may be more vulnerable to this undesirable effect, but a follow-up study is needed to demonstrate this.
Uusvaara
Juho
J
Unit of General Practice, Helsinki University Hospital, Helsinki, Finland. juho.uusvaara@kauniala.fi
Pitkala
Kaisu H
KH
Tienari
Pentti J
PJ
Kautiainen
Hannu
H
Tilvis
Reijo S
RS
Strandberg
Timo E
TE
D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000235:genetics*; D053327:Apolipoprotein E4 / Q000235:genetics*; D018680:Cholinergic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D003072:Cognition Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000235:genetics; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006580:Genetic Carrier Screening; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data*; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results
D053327:Apolipoprotein E4; D018680:Cholinergic Antagonists