Consider Alternatives to Anticholinergic Meds in Older Patients, Say Researchers
Older patients taking anticholinergic (AC) medication scored significantly lower on three separate brain atrophy and dysfunction tests compared to matched controls who took no AC medication.
Researchers analyzed data from two longitudinal cognitive studies; the Alzheimer's Disease Neuroimaging Initiative (ADNI), and the Indiana Memory and Aging Study (IMAS). All participants were deemed cognitively normal, with a total of 402 in ADNI, and 49 in IMAS. Fifty-two patients from the ADNI group and 8 from the IMAS group were deemed ‘AC+' i.e. taking at least one medication with medium or high AC activity.
The median age from both data sets was 73.3 years-old. For the ADNI participants data was taken at repeated visits of 3, 6, and 12 months after the baseline visit, and for IMAS participants data was taken every 18 months after the baseline visit.
Results showed significant worsening scores associated with AC use for the mean Logical Memory–Immediate score (raw mean scores: 13.27 for AC+ participants and 14.16 for AC− participants; P=.04). The AC medication users also showed inferior scores in the Trail Making Test Part B (raw mean scores: 97.85 seconds for AC+participants and 82.61 seconds for AC− participants; P=.04). AC+ patients also showed lower scores than AC− patients in the mean composite executive function score (raw mean scores: 0.58 for AC+ participants and 0.78 for AC− participants; P=.04).
The AC+ participants demonstrated reduced total cortical volume (raw mean values: 406134.21 mm3 for AC+ participants and 423107.01 mm3 for AC− participants; P=.02 and larger lateral ventricle (raw mean values: 17880.19 mm3 for AC+ participants and 15620.22 mm3 for AC− participants; P=.01) and inferior lateral ventricle volumes (raw mean values: 757.25 mm3 for AC+ participants and 571.49 mm3 for AC− participants; P<.001) relative to the AC− participants.
The authors suggest that their findings show AC properties in medications may be detrimental to brain structure and function, as well as cognition. They also found that the increased clinical progression from ‘cognitive normal' to ‘mild cognitive impairment' and/or Alzheimer's Disease was associated with AC medication use. The strength of these findings is enhanced by the finding that the highest total AC burden scores showed the most atrophy.
“These findings highlight the importance of considering the cognitive adverse effects of AC medications before using them to treat older adults at risk for cognitive decline in a clinical setting,” concluded the authors.
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