Dataset Information

Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis.

ABSTRACT: BACKGROUND:the long-term effect of the use of drugs with anticholinergic activity on cognitive function remains unclear. METHODS:we conducted a systematic review and meta-analysis of the relationship between anticholinergic drugs and risk of dementia, mild cognitive impairment (MCI) and cognitive decline in the older population. We identified studies published between January 2002 and April 2018 with ?12 weeks follow-up between strongly anticholinergic drug exposure and the study outcome measurement. We pooled adjusted odds ratios (OR) for studies reporting any, and at least short-term (90+ days) or long-term (365+ days) anticholinergic use for dementia and MCI outcomes, and standardised mean differences (SMD) in global cognition test scores for cognitive decline outcomes. Statistical heterogeneity was measured using the I2 statistic and risk of bias using ROBINS-I. RESULTS:twenty-six studies (including 621,548 participants) met our inclusion criteria. 'Any' anticholinergic use was associated with incident dementia (OR 1.20, 95% confidence interval [CI] 1.09-1.32, I2 =?86%). Short-term and long-term use were also associated with incident dementia (OR 1.23, 95% CI 1.17-1.29, I2 =?2%; and OR 1.50, 95% CI 1.22-1.85, I2 =?90%). 'Any' anticholinergic use was associated with cognitive decline (SMD 0.15; 95% CI 0.09-0.21, I2 =?3%) but showed no statistically significant difference for MCI (OR 1.24, 95% CI 0.97-1.59, I2 =?0%). CONCLUSIONS:anticholinergic drug use is associated with increased dementia incidence and cognitive decline in observational studies. However, a causal link cannot yet be inferred, as studies were observational with considerable risk of bias. Stronger evidence from high-quality studies is needed to guide the management of long-term use.

SUBMITTER: Pieper NT

PROVIDER: S-EPMC7583519 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis.

Pieper Nina T NT Grossi Carlota M CM Chan Wei-Yee WY Loke Yoon K YK Savva George M GM Haroulis Clara C Steel Nicholas N Fox Chris C Maidment Ian D ID Arthur Antony J AJ Myint Phyo K PK Smith Toby O TO Robinson Louise L Matthews Fiona E FE Brayne Carol C Richardson Kathryn K

Age and ageing 20201001 6

<h4>Background</h4>the long-term effect of the use of drugs with anticholinergic activity on cognitive function remains unclear.<h4>Methods</h4>we conducted a systematic review and meta-analysis of the relationship between anticholinergic drugs and risk of dementia, mild cognitive impairment (MCI) and cognitive decline in the older population. We identified studies published between January 2002 and April 2018 with ≥12 weeks follow-up between strongly anticholinergic drug exposure and the study ...[more]

PMID: 32603415

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Project description:Background/objectivePoor air quality is implicated as a risk factor for cognitive impairment and dementia. Few studies have examined these associations longitudinally in well-characterized population-based cohorts with standardized annual assessment of both mild cognitive impairment (MCI) and dementia. We investigated the association between estimated ambient fine particulate matter (PM2.5 ) and risk of incident MCI and dementia in a post-industrial region known for historically poor air quality.Setting/participantsAdults aged 65+ years in a population-based cohort (n = 1572).MeasurementsCensus tract level PM2.5 from Environmental Protection Agency (EPA) air quality monitors; Clinical Dementia Rating (CDR)®.DesignWe estimated ambient PM2.5 exposure (μg/m3 , single-year and 5-year averages) by geocoding participants' residential addresses to census tracts with daily EPA PM2.5 measurements from 2002 to 2014. Using Bayesian spatial regression modeling adjusted for age, sex, education, smoking history, and household income, we examined the association between estimated PM2.5 exposure and risk of incident MCI (CDR = 0.5) and incident dementia (CDR ≥ 1.0).ResultsModeling estimated single-year exposure, each 1 μg/m3 higher ambient PM2.5 was associated with 67% higher adjusted risk of incident dementia (hazard ratio [HR] = 1.669, 95% credible interval [CI]: 1.298, 2.136) and 75% higher adjusted risk of incident MCI (HR = 1.746, 95% CI: 1.518, 2.032). Estimates were higher when modeling 5-year ambient PM2.5 exposure for incident dementia (HR = 2.082, 95% CI: 1.528, 3.015) and incident MCI (HR = 3.419, 95% CI: 2.806, 4.164).ConclusionsHigher estimated ambient PM2.5 was associated with higher risk of incident MCI and dementia, particularly when considering longer-term exposure, and independent of demographic characteristics and smoking history. Targeting poor air quality may be a reasonable population-wide intervention to reduce the risk of cognitive impairment in older adults, particularly in regions exceeding current recommendations for safe exposure to PM2.5 .

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Dataset Information

Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis.

Publications

Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis.

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