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Anticholinergics and benzodiazepines on cognitive impairment among elderly with Alzheimer's disease: a 1 year follow-up study.

ABSTRACT: OBJECTIVE:Age-associated decline in central cholinergic activity makes older adults susceptible to harmful effects of anticholinergics (ACs). Evidence exists of an association between effects of AC medications on cognition. This retrospective cohort study examines how ACs affect cognition among older adults with Alzheimer's disease (AD) who received acetylcholine esterase inhibitors (AChEIs) over the course of 12 months. RESULTS:A total of 133 (80% women, mean age 78.38 years, SD 7.4) were recruited. No difference in sex, age and comorbid diseases was observed between participants who took ACs, benzodiazepines (BZDs) and AChEIs. The most common prescribed ACs was quetiapine, being used for behavioral and psychological symptoms (BPSD). Multilevel analysis showed that the change of mental state examination scores were significantly predicted in the group using ACs (t (169), -?2.52, p?=?.020) but not with the groups using BZD (t (162), 0.84, p?=?.440). Evidence showed that older adults with Alzheimer's disease and exposed to ACs exhibited lower global cognitive scores than those without AC exposure. Using ACs could be a trade-off between controlling BPSD and aggravating cognitive impairment. Highlighting the awareness of the potential anticholinergic effect is important and may be the best policy.

SUBMITTER: Jenraumjit R

PROVIDER: S-EPMC6941288 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Anticholinergics and benzodiazepines on cognitive impairment among elderly with Alzheimer's disease: a 1 year follow-up study.

Jenraumjit Rewadee R Chinwong Surarong S Chinwong Dujrudee D Kanjanarach Tipaporn T Kshetradat Thanat T Wongpakaran Tinakon T Wongpakaran Nahathai N

BMC research notes 20200102 1

<h4>Objective</h4>Age-associated decline in central cholinergic activity makes older adults susceptible to harmful effects of anticholinergics (ACs). Evidence exists of an association between effects of AC medications on cognition. This retrospective cohort study examines how ACs affect cognition among older adults with Alzheimer's disease (AD) who received acetylcholine esterase inhibitors (AChEIs) over the course of 12 months.<h4>Results</h4>A total of 133 (80% women, mean age 78.38 years, SD ...[more]

PMID: 31898553

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Project description:This study investigated the ability of magnetic resonance spectroscopy (1H-MRS) of posterior cingulate cortex (PCC) and brain volumetry to predict the progression from mild cognitive impairment (MCI) to Alzheimer's Disease (AD) on the basis of clinical classification at 2?years follow-up. Thirty-eight MCI patients, eighteen healthy older adults and twenty-three AD patients were included in this study. All participants underwent a brain-MR protocol (1.5?T GE scanner) including high-resolution T1-weighted volumetric sequence (isotropic 1mm3). Voxel-wise differences in brain volumetry were evaluated using FreeSurfer software and all volumes were normalized by the total intracranial volume (TIV). Careful localization of 1H-MRS volume of PCC was performed and data were processed with the LCModel program. MCI patients underwent a complete neuropsychological assessment at baseline and were clinically re-evaluated after a mean of 28?months; twenty-six MCI patients (68.4%) converted to AD and twelve remained stable. At baseline these two MCI subgroups did not differ in the global cognitive level (Mini Mental State Examination, MMSE) or in any of the other cognitive domains; the NAA/ mI ratio in the PCC was able to differentiate MCI converters from those MCI that did not develop AD (p?=?0.022) with a level of accuracy (AUC area) of 0.779. A significantly reduced volume of parahippocampal gyrus (p?=?0.010) and fusiform gyrus (p?=?0.026) were found in the converter MCI subgroup compared to the stable MCI subgroup. The combined use of both N- acetyl-aspartate (NAA)/myo-Inositol (mI) ratio and volume of parahippocampal gyrus, increases the overall accuracy (AUC?=?0.910) in predicting the conversion to AD two years before the development of clinical symptoms. Additional longitudinal studies with a broader representative sample of MCI patients and longer follow-up might be helpful to confirm these results and to elucidate the role of each parameter in predicting the possible progression to AD, and also to all the other non-AD dementia subtypes.

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Dataset Information

Anticholinergics and benzodiazepines on cognitive impairment among elderly with Alzheimer's disease: a 1 year follow-up study.

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Anticholinergics and benzodiazepines on cognitive impairment among elderly with Alzheimer's disease: a 1 year follow-up study.

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