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Role of anticholinergic burden in primary care patients with first cognitive complaints.
Eur J Neurol. 2017 07; 24(7):950-955.EJ

Abstract

BACKGROUND AND PURPOSE

Drugs with anticholinergic properties might have a negative impact on cognition, but findings are still conflicting. The association was evaluated between anticholinergic drugs and cognitive performance in primary care patients with first cognitive complaints.

METHODS

From April 2013 to March 2014, 353 general practitioners administered the Mini-Mental State Examination (MMSE) to patients presenting with first cognitive complaints. Drug history was collected and the anticholinergic cognitive burden (ACB) was scored and categorized as ACB 0, ACB 1 and ACB 2+. A mixed effect linear regression model was used to assess the association between ACB and MMSE score.

RESULTS

Of 4249 subjects entering the study (mean age 77 ± 8.2 years, 66.4% women and mean years of schooling 8.9 ± 4.5), 25.8% received at least one drug with anticholinergic action. According to multivariate analysis, and after adjustment for several confounders, subjects with ACB 2+ had a statistically significant lower MMSE score compared with those with ACB 0 (β -0.63; 95% confidence interval -1.19; -0.07). Subjects with ACB 1 had a non-statistically significant lower MMSE score than those with ACB 0 (β -0.11; 95% confidence interval -0.37; 0.15).

CONCLUSIONS

Anticholinergic medication might affect cognitive function in people with first cognitive complaints. Alternatives should be taken into account when possible, balancing the benefits and harms of these medications.

Authors+Show Affiliations

Department of Neurobiology, Care Sciences, and Society (NVS), Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden. Biomedical and Clinical Sciences Department, Center for Research and Treatment on Cognitive Dysfunctions, 'Luigi Sacco' Hospital, University of Milan, Milan, Italy.Unit of Neuroepidemiology, Carlo Besta Neurological Institute, I.R.C.C.S. Foundation, Milan, Italy.Department of Neurobiology, Care Sciences, and Society (NVS), Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden. Department of Geriatrics, Catholic University of Rome, Rome, Italy.Biomedical and Clinical Sciences Department, Center for Research and Treatment on Cognitive Dysfunctions, 'Luigi Sacco' Hospital, University of Milan, Milan, Italy.Biomedical and Clinical Sciences Department, Center for Research and Treatment on Cognitive Dysfunctions, 'Luigi Sacco' Hospital, University of Milan, Milan, Italy.Biomedical and Clinical Sciences Department, Center for Research and Treatment on Cognitive Dysfunctions, 'Luigi Sacco' Hospital, University of Milan, Milan, Italy.Scientific Direction, Carlo Besta Neurological Institute, I.R.C.C.S. Foundation, Milan, Italy.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28503836

Citation

Grande, G, et al. "Role of Anticholinergic Burden in Primary Care Patients With First Cognitive Complaints." European Journal of Neurology, vol. 24, no. 7, 2017, pp. 950-955.
Grande G, Tramacere I, Vetrano DL, et al. Role of anticholinergic burden in primary care patients with first cognitive complaints. Eur J Neurol. 2017;24(7):950-955.
Grande, G., Tramacere, I., Vetrano, D. L., Clerici, F., Pomati, S., Mariani, C., & Filippini, G. (2017). Role of anticholinergic burden in primary care patients with first cognitive complaints. European Journal of Neurology, 24(7), 950-955. https://doi.org/10.1111/ene.13313
Grande G, et al. Role of Anticholinergic Burden in Primary Care Patients With First Cognitive Complaints. Eur J Neurol. 2017;24(7):950-955. PubMed PMID: 28503836.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of anticholinergic burden in primary care patients with first cognitive complaints. AU - Grande,G, AU - Tramacere,I, AU - Vetrano,D L, AU - Clerici,F, AU - Pomati,S, AU - Mariani,C, AU - Filippini,G, AU - ,, Y1 - 2017/05/15/ PY - 2016/12/07/received PY - 2017/04/03/accepted PY - 2017/5/16/pubmed PY - 2018/3/1/medline PY - 2017/5/16/entrez KW - anticholinergic drugs KW - dementia KW - prevention KW - primary care SP - 950 EP - 955 JF - European journal of neurology JO - Eur J Neurol VL - 24 IS - 7 N2 - BACKGROUND AND PURPOSE: Drugs with anticholinergic properties might have a negative impact on cognition, but findings are still conflicting. The association was evaluated between anticholinergic drugs and cognitive performance in primary care patients with first cognitive complaints. METHODS: From April 2013 to March 2014, 353 general practitioners administered the Mini-Mental State Examination (MMSE) to patients presenting with first cognitive complaints. Drug history was collected and the anticholinergic cognitive burden (ACB) was scored and categorized as ACB 0, ACB 1 and ACB 2+. A mixed effect linear regression model was used to assess the association between ACB and MMSE score. RESULTS: Of 4249 subjects entering the study (mean age 77 ± 8.2 years, 66.4% women and mean years of schooling 8.9 ± 4.5), 25.8% received at least one drug with anticholinergic action. According to multivariate analysis, and after adjustment for several confounders, subjects with ACB 2+ had a statistically significant lower MMSE score compared with those with ACB 0 (β -0.63; 95% confidence interval -1.19; -0.07). Subjects with ACB 1 had a non-statistically significant lower MMSE score than those with ACB 0 (β -0.11; 95% confidence interval -0.37; 0.15). CONCLUSIONS: Anticholinergic medication might affect cognitive function in people with first cognitive complaints. Alternatives should be taken into account when possible, balancing the benefits and harms of these medications. SN - 1468-1331 UR - https://www.unboundmedicine.com/medline/citation/28503836/Role_of_anticholinergic_burden_in_primary_care_patients_with_first_cognitive_complaints_ L2 - https://doi.org/10.1111/ene.13313 DB - PRIME DP - Unbound Medicine ER -