Anticholinergic and sedative medication use in older patients with cognitive concerns

Caroline E Hinkle; Jennifer D Davis; Idania Arias; Allyson Goldstein; Lori Daiello; Seth A Margolis

doi:10.1111/jgs.18933

Anticholinergic and sedative medication use in older patients with cognitive concerns

J Am Geriatr Soc. 2024 Apr 29. doi: 10.1111/jgs.18933. Online ahead of print.

Authors

Caroline E Hinkle^{1

2}, Jennifer D Davis^{1

3}, Idania Arias³, Allyson Goldstein³, Lori Daiello^{4

5}, Seth A Margolis^{1

3}

Affiliations

¹ Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
² Mental Health and Behavioral Sciences Service, Providence VA Medical Center, Providence, Rhode Island, USA.
³ Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA.
⁴ Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
⁵ Department of Health Services, Policy, and Practice, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.

PMID: 38685717
DOI: 10.1111/jgs.18933

Abstract

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.

Keywords: MCI; cognition; dementia; medication use.

Abstract

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