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Anticholinergic Medication Use and Risk of Dementia Among Elderly Nursing Home Residents with Depression.
Am J Geriatr Psychiatry. 2016 06; 24(6):485-95.AJ

Abstract

OBJECTIVE

To examine the risk of dementia with anticholinergic use among elderly nursing home residents with depression.

DESIGN

Population-based nested case-control study.

SETTING

Population-based study involving 2007-2010 Minimum Data Set-linked Medicare data from all 50 states.

PARTICIPANTS

Medicare beneficiaries aged 65 years and older, diagnosed with depression, and no history of dementia as of 2007 (baseline period). Cases were identified as patients with incident dementia following the baseline period. For each case, four age- and sex-matched control subjects were selected using incidence density sampling.

MEASUREMENTS

Anticholinergic exposure was defined using Anticholinergic Drug Scale. Prescription of clinically significant anticholinergic medications (levels 2 and 3) 30 days preceding the event date formed the primary exposure. The primary outcome was dementia diagnosis, between January 1, 2008, and December 31, 2010. A conditional logistic regression model stratified on matched case-control sets was performed to assess dementia risk, after controlling for other risk factors.

RESULTS

The study sample included 28,388 cases diagnosed with dementia and 113,352 matched control subjects. After adjusting for other risk factors, clinically significant anticholinergic use was associated with significant risk of dementia (OR: 1.26; 95% CI: 1.22-1.29) compared with non-use. The findings remained consistent across levels of anticholinergic potency (level 2, OR: 1.37, 95% CI: 1.31-1.44; level 3, OR: 1.15, 95% CI: 1.10-1.19).

CONCLUSION

Use of clinically significant anticholinergic medications was associated with a 26% increase in risk of dementia among elderly nursing home residents with depression. With increasing safety concerns, there is a significant need to optimize anticholinergic use, especially for those who are at risk for dementia.

Authors+Show Affiliations

Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA.Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA.Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA.Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA.Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA. Electronic address: rraparasu@uh.edu.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

26976294

Citation

Chatterjee, Satabdi, et al. "Anticholinergic Medication Use and Risk of Dementia Among Elderly Nursing Home Residents With Depression." The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, vol. 24, no. 6, 2016, pp. 485-95.
Chatterjee S, Bali V, Carnahan RM, et al. Anticholinergic Medication Use and Risk of Dementia Among Elderly Nursing Home Residents with Depression. Am J Geriatr Psychiatry. 2016;24(6):485-95.
Chatterjee, S., Bali, V., Carnahan, R. M., Johnson, M. L., Chen, H., & Aparasu, R. R. (2016). Anticholinergic Medication Use and Risk of Dementia Among Elderly Nursing Home Residents with Depression. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 24(6), 485-95. https://doi.org/10.1016/j.jagp.2015.12.011
Chatterjee S, et al. Anticholinergic Medication Use and Risk of Dementia Among Elderly Nursing Home Residents With Depression. Am J Geriatr Psychiatry. 2016;24(6):485-95. PubMed PMID: 26976294.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anticholinergic Medication Use and Risk of Dementia Among Elderly Nursing Home Residents with Depression. AU - Chatterjee,Satabdi, AU - Bali,Vishal, AU - Carnahan,Ryan M, AU - Johnson,Michael L, AU - Chen,Hua, AU - Aparasu,Rajender R, Y1 - 2016/02/17/ PY - 2015/07/21/received PY - 2015/12/16/revised PY - 2015/12/22/accepted PY - 2016/3/16/entrez PY - 2016/3/16/pubmed PY - 2018/2/9/medline KW - Anticholinergic KW - dementia KW - depression KW - elderly SP - 485 EP - 95 JF - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry JO - Am J Geriatr Psychiatry VL - 24 IS - 6 N2 - OBJECTIVE: To examine the risk of dementia with anticholinergic use among elderly nursing home residents with depression. DESIGN: Population-based nested case-control study. SETTING: Population-based study involving 2007-2010 Minimum Data Set-linked Medicare data from all 50 states. PARTICIPANTS: Medicare beneficiaries aged 65 years and older, diagnosed with depression, and no history of dementia as of 2007 (baseline period). Cases were identified as patients with incident dementia following the baseline period. For each case, four age- and sex-matched control subjects were selected using incidence density sampling. MEASUREMENTS: Anticholinergic exposure was defined using Anticholinergic Drug Scale. Prescription of clinically significant anticholinergic medications (levels 2 and 3) 30 days preceding the event date formed the primary exposure. The primary outcome was dementia diagnosis, between January 1, 2008, and December 31, 2010. A conditional logistic regression model stratified on matched case-control sets was performed to assess dementia risk, after controlling for other risk factors. RESULTS: The study sample included 28,388 cases diagnosed with dementia and 113,352 matched control subjects. After adjusting for other risk factors, clinically significant anticholinergic use was associated with significant risk of dementia (OR: 1.26; 95% CI: 1.22-1.29) compared with non-use. The findings remained consistent across levels of anticholinergic potency (level 2, OR: 1.37, 95% CI: 1.31-1.44; level 3, OR: 1.15, 95% CI: 1.10-1.19). CONCLUSION: Use of clinically significant anticholinergic medications was associated with a 26% increase in risk of dementia among elderly nursing home residents with depression. With increasing safety concerns, there is a significant need to optimize anticholinergic use, especially for those who are at risk for dementia. SN - 1545-7214 UR - https://www.unboundmedicine.com/medline/citation/26976294/Anticholinergic_Medication_Use_and_Risk_of_Dementia_Among_Elderly_Nursing_Home_Residents_with_Depression_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1064-7481(16)00002-6 DB - PRIME DP - Unbound Medicine ER -