Volume 42, Issue 2 p. 134-144
ORIGINAL RESEARCH ARTICLE

Anticholinergic medication burden and cognitive function in participants of the ASPREE study

Jonathan C. Broder

Corresponding Author

Jonathan C. Broder

Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia

Correspondence

Jonathan C. Broder, Department of Epidemiology & Preventive Medicine, Monash University, Level 5, The Alfred Centre, 99 Commercial Road, Melbourne, Vic. 3004, Australia.

Email: [email protected]

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Joanne Ryan

Joanne Ryan

Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia

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Raj C. Shah

Raj C. Shah

Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University, Chicago, Illinois, USA

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Jessica E. Lockery

Jessica E. Lockery

Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia

Translational Immunology and Nanotechnology Research Program, RMIT University, Bundoora, Victoria, Australia

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Suzanne G. Orchard

Suzanne G. Orchard

Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia

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Julia F.-M. Gilmartin-Thomas

Julia F.-M. Gilmartin-Thomas

Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia

College of Health and Biomedicine & Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia

Australian Institute for Musculoskeletal Science, St Albans, Victoria, Australia

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Michelle A. Fravel

Michelle A. Fravel

Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA

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Alice J. Owen

Alice J. Owen

Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia

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Robyn L. Woods

Robyn L. Woods

Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia

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Rory Wolfe

Rory Wolfe

Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia

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Elsdon Storey

Elsdon Storey

Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia

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Anne M. Murray

Anne M. Murray

Berman Center for Outcomes and Clinical Research, Hennepin Health Research Institute, Minneapolis, Minnesota, USA

Division of Geriatrics, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA

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Michael E. Ernst

Michael E. Ernst

Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA

Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA

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First published: 06 December 2021
Citations: 5

Abstract

Study Objective

What is the association between anticholinergic burden and specific domains of cognitive function in older adults who are initially without major cognitive impairment?

Design

Post-hoc analysis of longitudinal observational data from the ASPirin in Reducing Events in the Elderly (ASPREE) study.

Patients

19,114 participants from Australia and the United States aged 70 years and older (65 years and older for US minorities) were recruited and followed for a median of 4.7 years. At enrollment, participants were free of known cardiovascular disease, major physical disability, or dementia.

Measurements

Cognitive assessments administered at baseline and biennially at follow-up visits included the Modified Mini-Mental State examination (3MS), Hopkins Verbal Learning Test–Revised (HVLT-R) delayed recall, Controlled Oral Word Association Test (COWAT), and Symbol Digit Modalities Test (SDMT). Anticholinergic burden was calculated at baseline using the Anticholinergic Cognitive Burden (ACB) scale and grouped as scores of 0 (no burden), 1-2 (low to moderate), or 3+ (high).

Main Results

Linear mixed effects models were used to assess the relationship between ACB score and cognition over time. After adjusting for sex, age, education, minority status, smoking status, hypertension, diabetes, depression, chronic kidney disease, country, and frailty, participants with a high ACB score had worse performance over time for 3MS (Adjusted [Adj] B=-0.092, P=0.034), HVLT-R delayed recall (Adj B=-0.104, P<0.001), COWAT (Adj B=-0.151, P<0.001), and SDMT (Adj B=-0.129, P=0.026), than participants with an ACB score of 0. A low to moderate ACB score was also associated with worse performance over time for HVLT-R delayed recall (Adj B=-0.037, P=0.007) and COWAT (Adj B=-0.065, P=0.003), compared to those with no ACB.

Conclusions

Anticholinergic burden predicts worse cognitive function over time in initially dementia-free older adults, particularly for executive function (COWAT) and episodic memory (HVLT-R).

CONFLICT OF INTEREST

Dr. Shah reports grants from National Institute on Aging, grants from Illinois Department of Public Health, during the conduct of the study; other from Alzheimer's Assocation—Illinois Chapter, other from Eli Lilly & Co., Inc., other from Genentech, Inc., other from Lundbeck, Inc., other from Merck & Co, Inc., other from Navidea Biopharmaceuticals, other from Novartis Pharmaceuticals, Inc., other from Takeda Development Center Americas, Inc., grants from NIH, grants from PCORI, grants from DOD, other from Amylyx Pharmaceuticals, Inc., other from Roche Holdings AG, other from Athira Pharma Inc., outside the submitted work.