title: Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study.
abstract: OBJECTIVE
  To determine whether the use of medications with possible and definite anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative.
  
  
  METHODS
  A 2-year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993.
  
  
  METHODS
  Community-dwelling and institutionalized participants.
  
  
  METHODS
  Thirteen thousand four participants aged 65 and older.
  
  
  METHODS
  Baseline use of possible or definite anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score 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 nonanticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI)=0.03-0.64, P=.03) than not taking anticholinergics, whereas the use of possible anticholinergics at baseline was not associated with further decline (0.02, 95% CI=-0.14-0.11, P=.79). Two-year mortality was greater for those taking definite (OR=1.68; 95% CI=1.30-2.16; P<.001) and possible (OR=1.56; 95% CI=1.36-1.79; P<.001) anticholinergics.
  
  
  CONCLUSIONS
  The use of medications with anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.
authors.affiliation: Department of Psychiatry, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK. chris.fox@uea.ac.uk
authors.forename: Chris
authors.initials: C
authors.lastname: Fox
authors.forename: Kathryn
authors.initials: K
authors.lastname: Richardson
authors.forename: Ian D
authors.initials: ID
authors.lastname: Maidment
authors.forename: George M
authors.initials: GM
authors.lastname: Savva
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Matthews
authors.forename: David
authors.initials: D
authors.lastname: Smithard
authors.forename: Simon
authors.initials: S
authors.lastname: Coulton
authors.forename: Cornelius
authors.initials: C
authors.lastname: Katona
authors.forename: Malaz A
authors.initials: MA
authors.lastname: Boustani
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D003072:Cognition Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D015897:Comorbidity; D004739:England; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D016017:Odds Ratio; D011446:Prospective Studies; D011594:Psychometrics; D012307:Risk Factors; D014852:Wales
chemical_list: D018680:Cholinergic Antagonists