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Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis.
Age Ageing. 2020 10 23; 49(6):939-947.AA

Abstract

BACKGROUND

the long-term effect of the use of drugs with anticholinergic activity on cognitive function remains unclear.

METHODS

we conducted a systematic review and meta-analysis of the relationship between anticholinergic drugs and risk of dementia, mild cognitive impairment (MCI) and cognitive decline in the older population. We identified studies published between January 2002 and April 2018 with ≥12 weeks follow-up between strongly anticholinergic drug exposure and the study outcome measurement. We pooled adjusted odds ratios (OR) for studies reporting any, and at least short-term (90+ days) or long-term (365+ days) anticholinergic use for dementia and MCI outcomes, and standardised mean differences (SMD) in global cognition test scores for cognitive decline outcomes. Statistical heterogeneity was measured using the I2 statistic and risk of bias using ROBINS-I.

RESULTS

twenty-six studies (including 621,548 participants) met our inclusion criteria. 'Any' anticholinergic use was associated with incident dementia (OR 1.20, 95% confidence interval [CI] 1.09-1.32, I2 = 86%). Short-term and long-term use were also associated with incident dementia (OR 1.23, 95% CI 1.17-1.29, I2 = 2%; and OR 1.50, 95% CI 1.22-1.85, I2 = 90%). 'Any' anticholinergic use was associated with cognitive decline (SMD 0.15; 95% CI 0.09-0.21, I2 = 3%) but showed no statistically significant difference for MCI (OR 1.24, 95% CI 0.97-1.59, I2 = 0%).

CONCLUSIONS

anticholinergic drug use is associated with increased dementia incidence and cognitive decline in observational studies. However, a causal link cannot yet be inferred, as studies were observational with considerable risk of bias. Stronger evidence from high-quality studies is needed to guide the management of long-term use.

Authors+Show Affiliations

University of East Anglia, Norwich, UK.University of East Anglia, Norwich, UK.University of East Anglia, Norwich, UK.University of East Anglia, Norwich, UK.University of East Anglia, Norwich, UK.James Paget Hospital, Gorleston, UK.University of East Anglia, Norwich, UK.University of East Anglia, Norwich, UK.Aston University, Birmingham, UK.University of East Anglia, Norwich, UK.University of Aberdeen, Aberdeen, UK.University of Oxford, Oxford, UK.Newcastle University, Newcastle upon Tyne, UK.Newcastle University, Newcastle upon Tyne, UK.University of Cambridge, Cambridge, UK.University of East Anglia, Norwich, UK.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

32603415

Citation

Pieper, Nina T., et al. "Anticholinergic Drugs and Incident Dementia, Mild Cognitive Impairment and Cognitive Decline: a Meta-analysis." Age and Ageing, vol. 49, no. 6, 2020, pp. 939-947.
Pieper NT, Grossi CM, Chan WY, et al. Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis. Age Ageing. 2020;49(6):939-947.
Pieper, N. T., Grossi, C. M., Chan, W. Y., Loke, Y. K., Savva, G. M., Haroulis, C., Steel, N., Fox, C., Maidment, I. D., Arthur, A. J., Myint, P. K., Smith, T. O., Robinson, L., Matthews, F. E., Brayne, C., & Richardson, K. (2020). Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis. Age and Ageing, 49(6), 939-947. https://doi.org/10.1093/ageing/afaa090
Pieper NT, et al. Anticholinergic Drugs and Incident Dementia, Mild Cognitive Impairment and Cognitive Decline: a Meta-analysis. Age Ageing. 2020 10 23;49(6):939-947. PubMed PMID: 32603415.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis. AU - Pieper,Nina T, AU - Grossi,Carlota M, AU - Chan,Wei-Yee, AU - Loke,Yoon K, AU - Savva,George M, AU - Haroulis,Clara, AU - Steel,Nicholas, AU - Fox,Chris, AU - Maidment,Ian D, AU - Arthur,Antony J, AU - Myint,Phyo K, AU - Smith,Toby O, AU - Robinson,Louise, AU - Matthews,Fiona E, AU - Brayne,Carol, AU - Richardson,Kathryn, PY - 2019/04/09/received PY - 2020/03/09/revised PY - 2020/04/14/accepted PY - 2020/7/1/pubmed PY - 2021/7/29/medline PY - 2020/7/1/entrez KW - anticholinergics KW - cognition KW - dementia KW - meta-analysis KW - older people KW - systematic review SP - 939 EP - 947 JF - Age and ageing JO - Age Ageing VL - 49 IS - 6 N2 - BACKGROUND: the long-term effect of the use of drugs with anticholinergic activity on cognitive function remains unclear. METHODS: we conducted a systematic review and meta-analysis of the relationship between anticholinergic drugs and risk of dementia, mild cognitive impairment (MCI) and cognitive decline in the older population. We identified studies published between January 2002 and April 2018 with ≥12 weeks follow-up between strongly anticholinergic drug exposure and the study outcome measurement. We pooled adjusted odds ratios (OR) for studies reporting any, and at least short-term (90+ days) or long-term (365+ days) anticholinergic use for dementia and MCI outcomes, and standardised mean differences (SMD) in global cognition test scores for cognitive decline outcomes. Statistical heterogeneity was measured using the I2 statistic and risk of bias using ROBINS-I. RESULTS: twenty-six studies (including 621,548 participants) met our inclusion criteria. 'Any' anticholinergic use was associated with incident dementia (OR 1.20, 95% confidence interval [CI] 1.09-1.32, I2 = 86%). Short-term and long-term use were also associated with incident dementia (OR 1.23, 95% CI 1.17-1.29, I2 = 2%; and OR 1.50, 95% CI 1.22-1.85, I2 = 90%). 'Any' anticholinergic use was associated with cognitive decline (SMD 0.15; 95% CI 0.09-0.21, I2 = 3%) but showed no statistically significant difference for MCI (OR 1.24, 95% CI 0.97-1.59, I2 = 0%). CONCLUSIONS: anticholinergic drug use is associated with increased dementia incidence and cognitive decline in observational studies. However, a causal link cannot yet be inferred, as studies were observational with considerable risk of bias. Stronger evidence from high-quality studies is needed to guide the management of long-term use. SN - 1468-2834 UR - https://www.unboundmedicine.com/medline/citation/32603415/Anticholinergic_drugs_and_incident_dementia_mild_cognitive_impairment_and_cognitive_decline:_a_meta_analysis_ L2 - https://academic.oup.com/ageing/article-lookup/doi/10.1093/ageing/afaa090 DB - PRIME DP - Unbound Medicine ER -