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Drug Burden Index and change in cognition over time in community-dwelling older men: the CHAMP study.
Ann Med. 2017 03; 49(2):157-164.AM

Abstract

OBJECTIVE

Anticholinergic and sedative medications are associated with acute cognitive impairment, but the long-term impact on change in cognition is unclear. This study investigated the effect of anticholinergic and sedative medications, quantified using the Drug Burden Index (DBI), on change in cognition over time in community-dwelling older men.

METHODS

This was a prospective cohort study of men aged ≥70 years in Sydney, Australia. DBI was assessed at baseline, 2, and 5 years. Cognitive performance was assessed using the Mini-Mental State Exam (MMSE) at each wave. Logistic quantile mixed-effects modelling was used to assess the adjusted effect of DBI on the median MMSE-time profile. Analyses were restricted to men with English-speaking backgrounds (n = 1059, 862, and 611 at baseline, 2, and 5 years).

RESULTS

Overall, 292 (27.7%), 258 (29.9%), and 189 (31.3%) men used anticholinergic or sedative medications at baseline, 2, and 5 years. There was a concave relationship between MMSE and time, where higher DBI corresponded to lower MMSE scores (coefficient: -0.161; 95% CI: -0.250 to -0.071) but not acceleration of declining MMSE over time.

CONCLUSIONS

Exposure to anticholinergic and sedative medications is associated with a small impairment in cognitive performance but not decline in cognition over time. KEY MESSAGES Exposure to anticholinergic and sedative medications, quantified using the Drug Burden Index, is associated with small cross-sectional impairments in cognitive performance. There was no evidence that exposure to anticholinergic and sedative medications is associated with accelerating decline in cognitive performance over a 5-year follow-up. Older people taking anticholinergic and sedative medications may derive immediate but small benefits in cognitive performance from clinical medication reviews to minimize or cease prescribing of these medications.

Authors+Show Affiliations

a Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences , Monash University , Parkville , VIC , Australia. b National Health and Medical Research Council Cognitive Decline Partnership Centre , Hornsby Ku-ring-gai Hospital , Hornsby , NSW , Australia.c Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute , Concord Hospital , Concord , NSW , Australia. d Faculty of Pharmacy , University of Sydney , Sydney , NSW , Australia.b National Health and Medical Research Council Cognitive Decline Partnership Centre , Hornsby Ku-ring-gai Hospital , Hornsby , NSW , Australia. e Kolling Institute of Medical Research , Sydney Medical School, University of Sydney , Sydney , NSW , Australia.a Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences , Monash University , Parkville , VIC , Australia.c Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute , Concord Hospital , Concord , NSW , Australia. f Sydney Medical School , University of Sydney , Sydney , NSW , Australia. g ANZAC Research Institute , University of Sydney, Concord Hospital , Concord , NSW , Australia.c Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute , Concord Hospital , Concord , NSW , Australia. f Sydney Medical School , University of Sydney , Sydney , NSW , Australia.f Sydney Medical School , University of Sydney , Sydney , NSW , Australia. g ANZAC Research Institute , University of Sydney, Concord Hospital , Concord , NSW , Australia.c Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute , Concord Hospital , Concord , NSW , Australia. f Sydney Medical School , University of Sydney , Sydney , NSW , Australia.c Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute , Concord Hospital , Concord , NSW , Australia. f Sydney Medical School , University of Sydney , Sydney , NSW , Australia.c Centre for Education and Research on Ageing and Ageing and Alzheimer's Institute , Concord Hospital , Concord , NSW , Australia. h Sydney School of Public Health , University of Sydney , Sydney , NSW , Australia.a Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences , Monash University , Parkville , VIC , Australia. b National Health and Medical Research Council Cognitive Decline Partnership Centre , Hornsby Ku-ring-gai Hospital , Hornsby , NSW , Australia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27763767

Citation

Jamsen, Kris M., et al. "Drug Burden Index and Change in Cognition Over Time in Community-dwelling Older Men: the CHAMP Study." Annals of Medicine, vol. 49, no. 2, 2017, pp. 157-164.
Jamsen KM, Gnjidic D, Hilmer SN, et al. Drug Burden Index and change in cognition over time in community-dwelling older men: the CHAMP study. Ann Med. 2017;49(2):157-164.
Jamsen, K. M., Gnjidic, D., Hilmer, S. N., Ilomäki, J., Le Couteur, D. G., Blyth, F. M., Handelsman, D. J., Naganathan, V., Waite, L. M., Cumming, R. G., & Bell, J. S. (2017). Drug Burden Index and change in cognition over time in community-dwelling older men: the CHAMP study. Annals of Medicine, 49(2), 157-164. https://doi.org/10.1080/07853890.2016.1252053
Jamsen KM, et al. Drug Burden Index and Change in Cognition Over Time in Community-dwelling Older Men: the CHAMP Study. Ann Med. 2017;49(2):157-164. PubMed PMID: 27763767.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Drug Burden Index and change in cognition over time in community-dwelling older men: the CHAMP study. AU - Jamsen,Kris M, AU - Gnjidic,Danijela, AU - Hilmer,Sarah N, AU - Ilomäki,Jenni, AU - Le Couteur,David G, AU - Blyth,Fiona M, AU - Handelsman,David J, AU - Naganathan,Vasi, AU - Waite,Louise M, AU - Cumming,Robert G, AU - Bell,J Simon, Y1 - 2016/11/18/ PY - 2016/10/21/pubmed PY - 2017/12/5/medline PY - 2016/10/21/entrez KW - Australia KW - Hypnotics and sedatives KW - aged KW - cholinergic antagonists KW - cognition disorders KW - cohort studies SP - 157 EP - 164 JF - Annals of medicine JO - Ann Med VL - 49 IS - 2 N2 - OBJECTIVE: Anticholinergic and sedative medications are associated with acute cognitive impairment, but the long-term impact on change in cognition is unclear. This study investigated the effect of anticholinergic and sedative medications, quantified using the Drug Burden Index (DBI), on change in cognition over time in community-dwelling older men. METHODS: This was a prospective cohort study of men aged ≥70 years in Sydney, Australia. DBI was assessed at baseline, 2, and 5 years. Cognitive performance was assessed using the Mini-Mental State Exam (MMSE) at each wave. Logistic quantile mixed-effects modelling was used to assess the adjusted effect of DBI on the median MMSE-time profile. Analyses were restricted to men with English-speaking backgrounds (n = 1059, 862, and 611 at baseline, 2, and 5 years). RESULTS: Overall, 292 (27.7%), 258 (29.9%), and 189 (31.3%) men used anticholinergic or sedative medications at baseline, 2, and 5 years. There was a concave relationship between MMSE and time, where higher DBI corresponded to lower MMSE scores (coefficient: -0.161; 95% CI: -0.250 to -0.071) but not acceleration of declining MMSE over time. CONCLUSIONS: Exposure to anticholinergic and sedative medications is associated with a small impairment in cognitive performance but not decline in cognition over time. KEY MESSAGES Exposure to anticholinergic and sedative medications, quantified using the Drug Burden Index, is associated with small cross-sectional impairments in cognitive performance. There was no evidence that exposure to anticholinergic and sedative medications is associated with accelerating decline in cognitive performance over a 5-year follow-up. Older people taking anticholinergic and sedative medications may derive immediate but small benefits in cognitive performance from clinical medication reviews to minimize or cease prescribing of these medications. SN - 1365-2060 UR - https://www.unboundmedicine.com/medline/citation/27763767/Drug_Burden_Index_and_change_in_cognition_over_time_in_community_dwelling_older_men:_the_CHAMP_study_ L2 - https://www.tandfonline.com/doi/full/10.1080/07853890.2016.1252053 DB - PRIME DP - Unbound Medicine ER -