Dataset Information

Anticholinergic Drug Use and Risk to Cognitive Performance in Older Adults with Questionable Cognitive Impairment: A Cross-Sectional Analysis.

ABSTRACT: Age-associated decline in central cholinergic activity makes older adults susceptible to the harmful effects of anticholinergic (AC) medications; however, there is an inadequate understanding of the association and possible effects of AC drugs on cognition. This cross-sectional study examines the associations of AC medications on cognition among older adults with questionable cognitive impairment (QCI).For this cross-sectional study, we used a multicenter database of community-dwelling older adults (N = 7351) aged 60+ years with QCI, from September 2005 to March 2014, as the baseline data. The Anticholinergic Drug Scale was used to categorize AC drug load into no, low, or moderate/high groups. Individuals with a Clinical Dementia Rating-Sum of Boxes score between 0.5 and 2.5 were identified as having QCI, while cognitive performance was evaluated using the Neuropsychological Test Battery. The mean z-scores of neuropsychological tests were grouped into a global cognition score.Participants who took AC medications were older, largely female, and had a higher prevalence of incontinence than those without AC exposure. Global cognition was significantly greater in the moderate/high-AC group than the no-AC group (-0.23 ± 0.53 vs. -0.32 ± 0.53). Multivariable linear regression showed that the global cognition score among the low- and moderate/high-AC groups, compared with the no-AC group, was 0.064 higher (p = 0.006 and p = 0.12, respectively).This cross-sectional study indicates that older adults with QCI who were exposed to AC medications might have higher global cognitive scores than those without AC exposure. The observed associations indicate that older adults might experience some beneficial cognitive effects from AC drugs, possibly due to the therapeutic effects of these medications in controlling comorbidities, thus outweighing their adverse effects on cognition.

SUBMITTER: Swami S

PROVIDER: S-EPMC5823249 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Anticholinergic Drug Use and Risk to Cognitive Performance in Older Adults with Questionable Cognitive Impairment: A Cross-Sectional Analysis.

Swami Sunil S Cohen Ronald A RA Kairalla John A JA Manini Todd M TM

Drugs & aging 20161101 11

<h4>Background</h4>Age-associated decline in central cholinergic activity makes older adults susceptible to the harmful effects of anticholinergic (AC) medications; however, there is an inadequate understanding of the association and possible effects of AC drugs on cognition. This cross-sectional study examines the associations of AC medications on cognition among older adults with questionable cognitive impairment (QCI).<h4>Methods</h4>For this cross-sectional study, we used a multicenter datab ...[more]

PMID: 27638818

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Project description:Wearable devices for remote and continuous health monitoring in older populations frequently include sensors for body temperature measurements (i.e., skin and core body temperatures). Healthy aging is associated with core body temperatures that are in the lower range of age-related normal values (36.3 ± 0.6°C, oral temperature), while patients with Alzheimer's disease (AD) exhibit core body temperatures above normal values (up to 0.2°C). However, the relation of body temperature measures with neurocognitive health in older adults remains unknown. This study aimed to explore the association of body temperature with cognitive performance in older adults with and without mild cognitive impairment (MCI). Eighty community-dwelling older adults (≥65 years) participated, of which 54 participants were cognitively healthy and 26 participants met the criteria for MCI. Skin temperatures at the rib cage and the scapula were measured in the laboratory (single-point measurement) and neuropsychological tests were conducted to assess general cognitive performance, episodic memory, verbal fluency, executive function, and processing speed. In a subgroup (n = 15, nine healthy, six MCI), skin and core body temperatures were measured continuously during 12 h of habitual daily activities (long-term measurement). Spearman's partial correlation analyses, controlled for age, revealed that lower median body temperature and higher peak-to-peak body temperature amplitude was associated with better general cognitive performance and with better performance in specific domains of cognition; [e.g., rib median skin temperature (single-point) vs. processing speed: rs = 0.33, p = 0.002; rib median skin temperature (long-term) vs. executive function: rs = 0.56, p = 0.023; and peak-to-peak core body temperature amplitude (long-term) vs. episodic memory: rs = 0.51, p = 0.032]. Additionally, cognitively healthy older adults showed lower median body temperature and higher peak-to-peak body temperature amplitude compared to older adults with MCI (e.g., rib median skin temperature, single-point: p = 0.035, r = 0.20). We conclude that both skin and core body temperature measures are potential early biomarkers of cognitive decline and preclinical symptoms of MCI/AD. It may therefore be promising to integrate body temperature measures into multi-parameter systems for the remote and continuous monitoring of neurocognitive health in older adults.

Project description:BackgroundMedications with potent anticholinergic properties have well-documented adverse effects. A high cumulative anticholinergic burden may arise from the concurrent use of multiple medications with weaker anticholinergic effects. We sought to identify patterns of high anticholinergic burden and associated patient characteristics.MethodsWe identified patients aged ≥ 65 who filled ≥ 1 medication with anticholinergic adverse effects in 2019 and had a cumulative Anticholinergic Burden score (ACB) ≥ 4 (i.e., high anticholinergic burden) in a large US health insurer. We classified patients based on how they attained high burden, as follows: 1) only filling strong or moderate anticholinergic medications (i.e., ACB = 2 or 3, "moderate/strong"), 2) only filling lightly anticholinergic medications (i.e., ACB = 1, "light/possible"), and 3) filling any combination ("mix"). We used multinomial logistic regression to assess the association between measured patient characteristics and membership in the three anticholinergic burden classifications, using the moderate/strong group as the referent.ResultsIn total, 83,286 eligible patients with high anticholinergic burden were identified (mean age: 74.3 years (SD:7.1), 72.9% female). Of these, 4.5% filled only strong/moderate anticholinergics, 4.3% filled only light/possible anticholinergics, and the rest filled a mix (91.2%). Within patients in the mixed group, 64.3% of medication fills were for light/possible anticholinergics, while 35.7% were for moderate/strong anticholinergics. Compared with patients in the moderate/strong anticholinergics group, patients filling only light/possible anticholinergics were more likely to be older (adjusted Odds Ratio [aOR] per 1-unit of age: 1.06, 95%CI: 1.05-1.07), less likely to be female (aOR: 0.56, 95%CI: 0.50-0.62 vs. male), more likely to have comorbidities (e.g., heart failure aOR: 3.18, 95%CI: 2.70-3.74 or depression aOR: 1.20, 95%CI: 1.09-1.33 vs. no comorbidity), and visited fewer physicians (aOR per 1-unit of change: 0.98, 95%CI: 0.97-0.98). Patients in the mixed group were older (aOR per 1-unit of age: 1.02, 95%CI: 1.02-1.03) and less likely to be female (aOR: 0.89, 95%CI: 0.82-0.97 vs. male) compared with those filling moderate/strong anticholinergics.ConclusionMost older adults accumulated high anticholinergic burden through a combination of light/possible and moderate/strong anticholinergics rather than moderate/strong anticholinergics, with light/possible anticholinergics being the major drivers of overall anticholinergic burden. These insights may inform interventions to improve prescribing in older adults.

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Dataset Information

Anticholinergic Drug Use and Risk to Cognitive Performance in Older Adults with Questionable Cognitive Impairment: A Cross-Sectional Analysis.

Publications

Anticholinergic Drug Use and Risk to Cognitive Performance in Older Adults with Questionable Cognitive Impairment: A Cross-Sectional Analysis.

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