title: Drug Burden Index and change in cognition over time in community-dwelling older men: the CHAMP study.
abstract: Anticholinergic and sedative medications are associated with acute cognitive impairment, but the long-term impact on change in cognition is unclear. This study investigated the effect of anticholinergic and sedative medications, quantified using the Drug Burden Index (DBI), on change in cognition over time in community-dwelling older men.
  
  
  
  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).
  
  
  
  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.
  
  
  
  Exposure to anticholinergic and sedative medications is associated with a small impairment in cognitive performance but not decline in cognition over time. KEY MESSAGES Exposure to anticholinergic and sedative medications, quantified using the Drug Burden Index, is associated with small cross-sectional impairments in cognitive performance. There was no evidence that exposure to anticholinergic and sedative medications is associated with accelerating decline in cognitive performance over a 5-year follow-up. Older people taking anticholinergic and sedative medications may derive immediate but small benefits in cognitive performance from clinical medication reviews to minimize or cease prescribing of these medications.
authors.affiliation: a Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences , Monash University , Parkville , VIC , Australia.|b National Health and Medical Research Council Cognitive Decline Partnership Centre , Hornsby Ku-ring-gai Hospital , Hornsby , NSW , Australia.
authors.forename: Kris M
authors.initials: KM
authors.lastname: Jamsen
authors.affiliation: c Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute , Concord Hospital , Concord , NSW , Australia.|d Faculty of Pharmacy , University of Sydney , Sydney , NSW , Australia.
authors.forename: Danijela
authors.initials: D
authors.lastname: Gnjidic
authors.affiliation: b National Health and Medical Research Council Cognitive Decline Partnership Centre , Hornsby Ku-ring-gai Hospital , Hornsby , NSW , Australia.|e Kolling Institute of Medical Research , Sydney Medical School, University of Sydney , Sydney , NSW , Australia.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
authors.affiliation: a Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences , Monash University , Parkville , VIC , Australia.
authors.forename: Jenni
authors.initials: J
authors.lastname: Ilomäki
authors.affiliation: c Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute , Concord Hospital , Concord , NSW , Australia.|f Sydney Medical School , University of Sydney , Sydney , NSW , Australia.|g ANZAC Research Institute , University of Sydney, Concord Hospital , Concord , NSW , Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Le Couteur
authors.affiliation: c Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute , Concord Hospital , Concord , NSW , Australia.|f Sydney Medical School , University of Sydney , Sydney , NSW , Australia.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Blyth
authors.affiliation: f Sydney Medical School , University of Sydney , Sydney , NSW , Australia.|g ANZAC Research Institute , University of Sydney, Concord Hospital , Concord , NSW , Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Handelsman
authors.affiliation: c Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute , Concord Hospital , Concord , NSW , Australia.|f Sydney Medical School , University of Sydney , Sydney , NSW , Australia.
authors.forename: Vasi
authors.initials: V
authors.lastname: Naganathan
authors.affiliation: c Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute , Concord Hospital , Concord , NSW , Australia.|f Sydney Medical School , University of Sydney , Sydney , NSW , Australia.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Waite
authors.affiliation: c Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute , Concord Hospital , Concord , NSW , Australia.|h Sydney School of Public Health , University of Sydney , Sydney , NSW , Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.affiliation: a Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences , Monash University , Parkville , VIC , Australia.|b National Health and Medical Research Council Cognitive Decline Partnership Centre , Hornsby Ku-ring-gai Hospital , Hornsby , NSW , Australia.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D018680:Cholinergic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D057187:Independent Living; D008297:Male; D000073216:Mental Status and Dementia Tests; D011446:Prospective Studies
chemical_list: D018680:Cholinergic Antagonists; D006993:Hypnotics and Sedatives
keywords: Australia; Hypnotics and sedatives; aged; cholinergic antagonists; cognition disorders; cohort studies