Monday, August 15, 2011

Anticholinergics linked to cognitive impairment, increased risk of death

Anticholinergic medications, which are used for a variety of indications including incontinence, may cause cognitive impairment and may increase the risk of death, according to the results of a large study in the UK. A total of 13,004 patients, aged 65 years and older, were evaluated as part of the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS), a 2-year longitudinal multicenter study investigating health and cognitive function in older adults. At baseline, 9,850 patients (79 percent) reported taking any medication, 5,709 (47 percent) admitted use of medication with possible anticholinergic properties, and 508 (4 percent) said they definitely used anticholinergics. The most frequently used anticholinergic agents were furosemide (N=1,384), dextropropoxyphene (N=955), atenolol (N=992) and nifedipine (N=752), with women more likely to report taking anticholinergic agents than men (7,420 versus 5,003, respectively). [J Am Geriatr Soc 2011 Jun 24. doi: 10.1111/j.1532-5415.2011.03491.x.] At follow-up, the researchers found that patients taking medications with definite anticholinergic effects had a significantly greater 0.33-point decline in their Mini-Mental State Examination (MMSE) score compared to patients not taking anticholinergics (P=0.03). Of particular concern, patients taking definite anticholinergics and possible anticholinergics had a significantly higher mortality rate than patients not using anticholinergics (both P<0.001). “Our findings make it clear that clinicians need to review the cumulative anticholinergic burden in people presenting with cognitive impairment to determine if the drugs are causing decline in mental status,” said Dr. Malaz Boustani, co-author of the study and associate professor at the Indiana University School of Medicine in Indianapolis, Indiana, US. “Physicians should review with older patients all the over-the-counter and prescription drugs they are taking to determine exposure.” “We found that medications with definite anticholinergic effects are independently associated with a greater risk of cognitive decline and death,” added study author Dr. Chris Fox, a psychiatrist from the University of East Anglia, Norwich, UK. While the results of this study are consistent with those of previous trials, the authors said that further research would be needed to determine the effect of of different doses of medicines with anticholinergic activity on mortality. Anticholinergics affect the brain by blocking the central nervous system neurotransmitter acetylcholine. Many drugs with anticholinergic activity are available over-the-counter or by prescription that are taken by adults for a variety of indications, from sleep problems to incontinence.

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