title: Anticholinergic Drug Use and Risk to Cognitive Performance in Older Adults with Questionable Cognitive Impairment: A Cross-Sectional Analysis.
abstract: Age-associated decline in central cholinergic activity makes older adults susceptible to the harmful effects of anticholinergic (AC) medications; however, there is an inadequate understanding of the association and possible effects of AC drugs on cognition. This cross-sectional study examines the associations of AC medications on cognition among older adults with questionable cognitive impairment (QCI).
  
  
  
  For this cross-sectional study, we used a multicenter database of community-dwelling older adults (N = 7351) aged 60+ years with QCI, from September 2005 to March 2014, as the baseline data. The Anticholinergic Drug Scale was used to categorize AC drug load into no, low, or moderate/high groups. Individuals with a Clinical Dementia Rating-Sum of Boxes score between 0.5 and 2.5 were identified as having QCI, while cognitive performance was evaluated using the Neuropsychological Test Battery. The mean z-scores of neuropsychological tests were grouped into a global cognition score.
  
  
  
  Participants who took AC medications were older, largely female, and had a higher prevalence of incontinence than those without AC exposure. Global cognition was significantly greater in the moderate/high-AC group than the no-AC group (-0.23 ± 0.53 vs. -0.32 ± 0.53). Multivariable linear regression showed that the global cognition score among the low- and moderate/high-AC groups, compared with the no-AC group, was 0.064 higher (p = 0.006 and p = 0.12, respectively).
  
  
  
  This cross-sectional study indicates that older adults with QCI who were exposed to AC medications might have higher global cognitive scores than those without AC exposure. The observed associations indicate that older adults might experience some beneficial cognitive effects from AC drugs, possibly due to the therapeutic effects of these medications in controlling comorbidities, thus outweighing their adverse effects on cognition.
authors.affiliation: Department of Epidemiology, University of Florida, Gainesville, FL, USA. drsunil81@ufl.edu.|Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA. drsunil81@ufl.edu.
authors.forename: Sunil
authors.identifier: 0000-0003-1592-5279
authors.initials: S
authors.lastname: Swami
authors.affiliation: Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.|Center for Cognitive Aging and Memory, Aging and Geriatric Research, University of Florida, Gainesville, FL, USA.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Cohen
authors.affiliation: Department of Biostatistics, University of Florida, Gainesville, FL, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Kairalla
authors.affiliation: Department of Epidemiology, University of Florida, Gainesville, FL, USA.|Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Manini
mesh_terms: D000368:Aged; D000375:Aging / Q000187:drug effects / Q000523:psychology; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003071:Cognition / Q000187:drug effects*; D060825:Cognitive Dysfunction / Q000139:chemically induced* / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D015995:Prevalence; D012306:Risk
chemical_list: D018680:Cholinergic Antagonists