Anticholinergic and sedative medication use in older patients with cognitive concerns

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 72; no. 9; pp. 2792 - 2799
• Main Authors: Hinkle, Caroline E., Davis, Jennifer D., Arias, Idania, Goldstein, Allyson, Daiello, Lori, Margolis, Seth A.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.09.2024; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Anesthesia; Anticholinergics; Cholinergic Antagonists - adverse effects; cognition; Cognition & reasoning; Cognition - drug effects; Cognitive Dysfunction - chemically induced; Cognitive Dysfunction - epidemiology; Comorbidity; Cross-Sectional Studies; Dementia; Executive function; Executive Function - drug effects; Female; Humans; Hypnotics and Sedatives - adverse effects; Hypnotics and Sedatives - therapeutic use; Information processing; Male; MCI; medication use; Memory; Middle Aged; Neuropsychological Tests; Older people; Polypharmacy; Risk Factors; Sedatives; medication use; dementia; MCI; cognition
• ISSN: 0002-8614; 1532-5415; 1532-5415
• DOI: 10.1111/jgs.18933

Background Anticholinergic (AC) and sedative medications are a risk factor for cognitive impairment. This study sought to characterize AC and sedative use in older patients seen for outpatient neuropsychological evaluation and evaluate their associations with different cognitive domains. We hypothesized that AC and sedative use would be associated with worse attention/processing speed (AP), executive functioning (EF), and memory. Methods We conducted a cross‐sectional chart review of 392 patients (mean [M] age = 72 ± 7.7 years, range = 54–91). Medications were characterized by number of AC medications (≥1 on the Anticholinergic Cognitive Burden Scale [ACB]), number of sedative medications, and polypharmacy (≥5 daily medications). Demographically adjusted composites were calculated for AP, EF, and memory. Bivariate Pearson correlations assessed relationships between medication use and cognition. Multivariate linear regressions evaluated significant medication‐cognition associations, controlling for total medications, medical comorbidities, and estimated premorbid cognitive functioning. Results Polypharmacy was common (80%; n = 314). Most patients (70%; n = 275) used ≥1 sedative medications (range = 0–9). Over half (63%; n = 248) used ≥1 AC drugs (range = 0–7), yet ACB scores were ≤2 in 74% of patients. Sedative use was negatively correlated with AP (r = −0.134, p = 0.008) and EF (r = −0.105, p = 0.04). ACB scores were negatively correlated with AP (r = −0.106, p = 0.037). Sedatives and a priori covariates significantly predicted AP performance (R2 = 0.127, p < 0.001); using more sedative medications was uniquely associated with worse AP (β = −0.426, p = 0.049). No significant associations were found with memory. Conclusion AC and sedative medications and polypharmacy were prevalent in this sample of older patients. Though both drug classes had negative relationships with AP and EF, sedatives had a particularly negative association with AP. Contrary to our hypotheses, memory was not associated with medication use; however, anticholinergic burden was low within the sample, and AP and EF deficits may masquerade as memory problems.