Dataset Information

A Cohort Study of Anticholinergic Medication Burden and Incident Dementia and Stroke in Older Adults.

ABSTRACT:

Background

Anticholinergic medications may increase risk of dementia and stroke, but prospective studies in healthy older people are lacking.

Objective

Compare risk of incident dementia and stroke by anticholinergic burden among initially healthy older people.

Design

Prospective cohort study.

Setting

Primary care (Australia and USA).

Participants

19,114 community-dwelling participants recruited for the ASPREE trial, aged 70+ years (65+ if US minorities) without major cardiovascular disease, dementia diagnosis, or Modified Mini-Mental State Examination score below 78/100.

Measurements

Baseline anticholinergic exposure was calculated using the Anticholinergic Cognitive Burden (ACB) score. Dementia was adjudicated using Diagnostic and Statistical Manual of Mental Disorders volume IV criteria, and stroke using the World Health Organization definition.

Results

At baseline, 15,000 participants (79%) had an ACB score of zero, 2930 (15%) a score of 1-2, and 1184 (6%) a score of ≥ 3 (indicating higher burden). After a median follow-up of 4.7 years and adjusting for baseline covariates, a baseline ACB score of ≥ 3 was associated with increased risk of ischemic stroke (adjusted HR 1.58, 95% CI 1.06, 2.35), or dementia (adjusted HR 1.36, 95% CI 1.01, 1.82), especially of mixed etiology (adjusted HR 1.53, 95% CI 1.06, 2.21). Results were similar for those exposed to moderate/highly anticholinergic medications.

Limitations

Residual confounding and reverse causality are possible. Assessment of dose or duration was not possible.

Conclusions

High anticholinergic burden in initially healthy older people was associated with increased risk of incident dementia and ischemic stroke. A vascular effect may underlie this association. These findings highlight the importance of minimizing anticholinergic exposure in healthy older people.

SUBMITTER: Lockery JE

PROVIDER: S-EPMC8175463 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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Publications

A Cohort Study of Anticholinergic Medication Burden and Incident Dementia and Stroke in Older Adults.

Lockery Jessica E JE Broder Jonathan C JC Ryan Joanne J Stewart Ashley C AC Woods Robyn L RL Chong Trevor T-J TT Cloud Geoffrey C GC Murray Anne A Rigby Jason D JD Shah Raj R Storey Elsdon E Ward Stephanie A SA Wolfe Rory R Reid Christopher M CM Collyer Taya A TA Ernst Michael E ME

Journal of general internal medicine 20210322 6

<h4>Background</h4>Anticholinergic medications may increase risk of dementia and stroke, but prospective studies in healthy older people are lacking.<h4>Objective</h4>Compare risk of incident dementia and stroke by anticholinergic burden among initially healthy older people.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>Primary care (Australia and USA).<h4>Participants</h4>19,114 community-dwelling participants recruited for the ASPREE trial, aged 70+ years (65+ if US minorities) withou ...[more]

PMID: 33754317

Similar Datasets

Project description:BackgroundThe complexity of medication therapy in older adults with multiple comorbidities often leads to inappropriate prescribing. Drugs with anticholinergic properties are of particular interest because many are not recognized for this property; their use may lead to increased anticholinergic burden resulting in significant health risks, as well as negatively impacting cognition. Medication therapy management (MTM) interventions showed promise in addressing inappropriate medication use, but the effectiveness of targeted multidisciplinary team interventions addressing anticholinergic medications in older populations is yet to be determined.MethodsWe conducted an 8-week, parallel-arm, randomized trial to evaluate whether a targeted patient-centered pharmacist-physician team MTM intervention ("targeted MTM intervention") reduced the use of inappropriate anticholinergic medications in older patients enrolled in a longitudinal cohort at University of Kentucky's Alzheimer's Disease Center. Study outcomes included changes in the medication appropriateness index (MAI) targeting anticholinergic medications and in the anticholinergic drug scale (ADS) score from baseline to the end of study.ResultsBetween October 1, 2014 and September 30, 2015 we enrolled and randomized 50 participants taking at least one medication with anticholinergic properties. Of these, 35 (70%) were women, 45 (90%) were white, and 33 (66%) were cognitively intact (clinical dementia rating [CDR] = 0); mean age was 77.7 ± 6.6 years. At baseline, the mean MAI was 12.6 ± 6.3; 25 (50%) of the participants used two or more anticholinergics, and the mean ADS score was 2.8 ± 1.6. After randomization, although no statistically significant difference was noted between groups, we identified a potentially meaningful imbalance as the intervention group had more participants with intact cognition, and thus included CDR in all of the analyses. The targeted MTM intervention resulted in statistically significant CDR adjusted differences between groups with regard to improved MAI (change score of 3.6 (1.1) for the MTM group as compared with 1.0 (0.9) for the control group, p = 0.04) and ADS (change score of 1.0 (0.3) for the MTM group as compared with 0.2 (0.3) for the control group, p = 0.03).ConclusionsOur targeted MTM intervention resulted in improvement in anticholinergic medication appropriateness and reduced the use of inappropriate anticholinergic medications in older patients. Our results show promise in an area of great importance to ensure optimum outcomes for medications used in older adults.Trial registrationClinicalTrials.gov NCT02172612 . Registered 20 June 2014.

Dataset Information

A Cohort Study of Anticholinergic Medication Burden and Incident Dementia and Stroke in Older Adults.

Background

Objective

Design

Setting

Participants

Measurements

Results

Limitations

Conclusions

Publications

A Cohort Study of Anticholinergic Medication Burden and Incident Dementia and Stroke in Older Adults.

Similar Datasets

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