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 A. Boustani, Fred Unverzagt

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


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)
Pages (from-to)511-519
Number of pages9
Issue number5
StatePublished - May 2018


  • adverse drug reaction
  • anticholinergic
  • dementia
  • mild cognitive impairment
  • modifiable risk factors
  • pharmacoepidemiology
  • primary care

ASJC Scopus subject areas

  • Pharmacology (medical)

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