Anticholinergics Influence Transition from Normal Cognition to Mild Cognitive Impairment in Older Adults in Primary Care

Noll L. Campbell, Kathleen A. Lane, Sujuan Gao, Malaz Boustani, Frederick Unverzagt

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Study Objective: To determine the influence of anticholinergic medications on transitions in cognitive diagnosis of older adults in primary care. Design: This observational cohort study was conducted over a mean follow-up of 3.2 years. Anticholinergic exposure was defined by pharmacy dispensing and claims records. Cognitive diagnosis was performed by an expert panel at baseline and annually up to 4 years. Data Source: Medication exposure and other clinical data were extracted from the Indiana Network for Patient Care (INPC). The cognitive diagnosis was derived from a cognitive screening and diagnosis study. Participants: A total of 350 adults 65 years and older without dementia and receiving primary care in a safety net health care system. Measurement and Main Results: Cognitive diagnosis followed a two-phase screening and consensus-based neuropsychiatric examination to determine a baseline diagnosis as normal cognition, mild cognitive impairment (MCI), or dementia, with a follow-up neuropsychiatric examination and consensus-based diagnosis repeated annually. The Anticholinergic Cognitive Burden scale was used to identify anticholinergics dispensed up to 10 years before enrollment and annually throughout the study. A total standard daily dose of anticholinergics was calculated by using pharmacy dispensing data from the INPC. Among 350 participants, a total of 978 diagnostic assessments were completed over a mean follow-up of 3.2 years. Compared with stable cognition, increasing use of strong anticholinergics calculated by total standard daily dose increased the odds of transition from normal cognition to MCI (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.01-1.31, p = 0.0342). Compared with stable MCI, strong anticholinergics did not influence the reversion of MCI to normal cognition (OR 0.95, 95% CI 0.86-1.05, p = 0.3266). Conclusion: De-prescribing interventions in older adults with normal cognition should test anticholinergics as potentially modifiable risk factors for cognitive impairment.

Original languageEnglish (US)
JournalPharmacotherapy
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Cholinergic Antagonists
Cognition
Primary Health Care
Dementia
Consensus
Patient Care
Odds Ratio
Confidence Intervals
Cognitive Dysfunction
Information Storage and Retrieval
Observational Studies
Cohort Studies
Delivery of Health Care
Safety

Keywords

  • Adverse drug reaction
  • Anticholinergic
  • Dementia
  • Mild cognitive impairment
  • Modifiable risk factors
  • Pharmacoepidemiology
  • Primary care

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

@article{3cb52d002d2c42c3a9076a0207f0bc97,
title = "Anticholinergics Influence Transition from Normal Cognition to Mild Cognitive Impairment in Older Adults in Primary Care",
abstract = "Study Objective: To determine the influence of anticholinergic medications on transitions in cognitive diagnosis of older adults in primary care. Design: This observational cohort study was conducted over a mean follow-up of 3.2 years. Anticholinergic exposure was defined by pharmacy dispensing and claims records. Cognitive diagnosis was performed by an expert panel at baseline and annually up to 4 years. Data Source: Medication exposure and other clinical data were extracted from the Indiana Network for Patient Care (INPC). The cognitive diagnosis was derived from a cognitive screening and diagnosis study. Participants: A total of 350 adults 65 years and older without dementia and receiving primary care in a safety net health care system. Measurement and Main Results: Cognitive diagnosis followed a two-phase screening and consensus-based neuropsychiatric examination to determine a baseline diagnosis as normal cognition, mild cognitive impairment (MCI), or dementia, with a follow-up neuropsychiatric examination and consensus-based diagnosis repeated annually. The Anticholinergic Cognitive Burden scale was used to identify anticholinergics dispensed up to 10 years before enrollment and annually throughout the study. A total standard daily dose of anticholinergics was calculated by using pharmacy dispensing data from the INPC. Among 350 participants, a total of 978 diagnostic assessments were completed over a mean follow-up of 3.2 years. Compared with stable cognition, increasing use of strong anticholinergics calculated by total standard daily dose increased the odds of transition from normal cognition to MCI (odds ratio [OR] 1.15, 95{\%} confidence interval [CI] 1.01-1.31, p = 0.0342). Compared with stable MCI, strong anticholinergics did not influence the reversion of MCI to normal cognition (OR 0.95, 95{\%} CI 0.86-1.05, p = 0.3266). Conclusion: De-prescribing interventions in older adults with normal cognition should test anticholinergics as potentially modifiable risk factors for cognitive impairment.",
keywords = "Adverse drug reaction, Anticholinergic, Dementia, Mild cognitive impairment, Modifiable risk factors, Pharmacoepidemiology, Primary care",
author = "Campbell, {Noll L.} and Lane, {Kathleen A.} and Sujuan Gao and Malaz Boustani and Frederick Unverzagt",
year = "2018",
month = "1",
day = "1",
doi = "10.1002/phar.2106",
language = "English (US)",
journal = "Pharmacotherapy",
issn = "0277-0008",
publisher = "Pharmacotherapy Publications Inc.",

}

TY - JOUR

T1 - Anticholinergics Influence Transition from Normal Cognition to Mild Cognitive Impairment in Older Adults in Primary Care

AU - Campbell, Noll L.

AU - Lane, Kathleen A.

AU - Gao, Sujuan

AU - Boustani, Malaz

AU - Unverzagt, Frederick

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Study Objective: To determine the influence of anticholinergic medications on transitions in cognitive diagnosis of older adults in primary care. Design: This observational cohort study was conducted over a mean follow-up of 3.2 years. Anticholinergic exposure was defined by pharmacy dispensing and claims records. Cognitive diagnosis was performed by an expert panel at baseline and annually up to 4 years. Data Source: Medication exposure and other clinical data were extracted from the Indiana Network for Patient Care (INPC). The cognitive diagnosis was derived from a cognitive screening and diagnosis study. Participants: A total of 350 adults 65 years and older without dementia and receiving primary care in a safety net health care system. Measurement and Main Results: Cognitive diagnosis followed a two-phase screening and consensus-based neuropsychiatric examination to determine a baseline diagnosis as normal cognition, mild cognitive impairment (MCI), or dementia, with a follow-up neuropsychiatric examination and consensus-based diagnosis repeated annually. The Anticholinergic Cognitive Burden scale was used to identify anticholinergics dispensed up to 10 years before enrollment and annually throughout the study. A total standard daily dose of anticholinergics was calculated by using pharmacy dispensing data from the INPC. Among 350 participants, a total of 978 diagnostic assessments were completed over a mean follow-up of 3.2 years. Compared with stable cognition, increasing use of strong anticholinergics calculated by total standard daily dose increased the odds of transition from normal cognition to MCI (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.01-1.31, p = 0.0342). Compared with stable MCI, strong anticholinergics did not influence the reversion of MCI to normal cognition (OR 0.95, 95% CI 0.86-1.05, p = 0.3266). Conclusion: De-prescribing interventions in older adults with normal cognition should test anticholinergics as potentially modifiable risk factors for cognitive impairment.

AB - Study Objective: To determine the influence of anticholinergic medications on transitions in cognitive diagnosis of older adults in primary care. Design: This observational cohort study was conducted over a mean follow-up of 3.2 years. Anticholinergic exposure was defined by pharmacy dispensing and claims records. Cognitive diagnosis was performed by an expert panel at baseline and annually up to 4 years. Data Source: Medication exposure and other clinical data were extracted from the Indiana Network for Patient Care (INPC). The cognitive diagnosis was derived from a cognitive screening and diagnosis study. Participants: A total of 350 adults 65 years and older without dementia and receiving primary care in a safety net health care system. Measurement and Main Results: Cognitive diagnosis followed a two-phase screening and consensus-based neuropsychiatric examination to determine a baseline diagnosis as normal cognition, mild cognitive impairment (MCI), or dementia, with a follow-up neuropsychiatric examination and consensus-based diagnosis repeated annually. The Anticholinergic Cognitive Burden scale was used to identify anticholinergics dispensed up to 10 years before enrollment and annually throughout the study. A total standard daily dose of anticholinergics was calculated by using pharmacy dispensing data from the INPC. Among 350 participants, a total of 978 diagnostic assessments were completed over a mean follow-up of 3.2 years. Compared with stable cognition, increasing use of strong anticholinergics calculated by total standard daily dose increased the odds of transition from normal cognition to MCI (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.01-1.31, p = 0.0342). Compared with stable MCI, strong anticholinergics did not influence the reversion of MCI to normal cognition (OR 0.95, 95% CI 0.86-1.05, p = 0.3266). Conclusion: De-prescribing interventions in older adults with normal cognition should test anticholinergics as potentially modifiable risk factors for cognitive impairment.

KW - Adverse drug reaction

KW - Anticholinergic

KW - Dementia

KW - Mild cognitive impairment

KW - Modifiable risk factors

KW - Pharmacoepidemiology

KW - Primary care

UR - http://www.scopus.com/inward/record.url?scp=85046008568&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046008568&partnerID=8YFLogxK

U2 - 10.1002/phar.2106

DO - 10.1002/phar.2106

M3 - Article

C2 - 29600808

AN - SCOPUS:85046008568

JO - Pharmacotherapy

JF - Pharmacotherapy

SN - 0277-0008

ER -