Cumulative Anticholinergic Exposure Is Associated with Poor Memory and Executive Function in Older Men
Article first published online: 19 NOV 2008
© 2008, Copyright the Authors. Journal compilation © 2008, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 56, Issue 12, pages 2203–2210, December 2008
How to Cite
Han, L., Agostini, J. V. and Allore, H. G. (2008), Cumulative Anticholinergic Exposure Is Associated with Poor Memory and Executive Function in Older Men. Journal of the American Geriatrics Society, 56: 2203–2210. doi: 10.1111/j.1532-5415.2008.02009.x
- Issue published online: 2 DEC 2008
- Article first published online: 19 NOV 2008
- anticholinergic score;
- medication use;
- cognitive test;
- cohort study;
- older men;
OBJECTIVES: To examine the longitudinal relationship between cumulative exposure to anticholinergic medications and memory and executive function in older men.
DESIGN: Prospective cohort study.
SETTING: A Department of Veterans Affairs primary care clinic.
PARTICIPANTS: Five hundred forty-four community-dwelling men aged 65 and older with diagnosed hypertension.
MEASUREMENTS: The outcomes were measured using the Hopkins Verbal Recall Test (HVRT) for short-term memory and the instrumental activity of daily living (IADL) scale for executive function at baseline and during follow-up. Anticholinergic medication use was ascertained using participants' primary care visit records and quantified as total anticholinergic burden using a clinician-rated anticholinergic score.
RESULTS: Cumulative exposure to anticholinergic medications over the preceding 12 months was associated with poorer performance on the HVRT and IADLs. On average, a 1-unit increase in the total anticholinergic burden per 3 months was associated with a 0.32-point (95% confidence interval (CI)= 0.05–0.58) and 0.10-point (95% CI=0.04–0.17) decrease in the HVRT and IADLs, respectively, independent of other potential risk factors for cognitive impairment, including age, education, cognitive and physical function, comorbidities, and severity of hypertension. The association was attenuated but remained statistically significant with memory (0.29, 95% CI=0.01–0.56) and executive function (0.08, 95% CI=0.02–0.15) after further adjustment for concomitant non-anticholinergic medications.
CONCLUSION: Cumulative anticholinergic exposure across multiple medications over 1 year may negatively affect verbal memory and executive function in older men. Prescription of drugs with anticholinergic effects in older persons deserves continued attention to avoid deleterious adverse effects.