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Cornelius Katona - One of the best experts on this subject based on the ideXlab platform.
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Anticholinergic medication use and cognitive impairment in the older population the medical research council cognitive function and ageing study
Journal of the American Geriatrics Society, 2011Co-Authors: Chris Fox, Kathryn Richardson, Ian Maidment, George M Savva, Fiona E Matthews, David G Smithard, Simon Coulton, Cornelius KatonaAbstract:PARTICIPANTS: Thirteen thousand four participants aged 65 and older. MEASUREMENTS: Baseline use of possible or definite Anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. RESULTS: At baseline, 47% of the population used a medication with possible Anticholinergic properties, and 4% used a drug with definite Anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonAnticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite Anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI) 50.03‐0.64, P 5.03) than not taking Anticholinergics, whereas the use of possible Anticholinergics at baseline was not associated with further decline (0.02, 95% CI 5 0.14‐0.11, P 5.79). Twoyear mortality was greater for those taking definite (OR 51.68; 95% CI 51.30‐2.16; Po.001) and possible (OR 51.56; 95% CI 51.36‐1.79;Po.001) Anticholinergics. CONCLUSION: The use of medications with Anticholinergic activity increases the cumulative risk of cognitive impairment and mortality. J Am Geriatr Soc 2011.
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Anticholinergic medication use and cognitive impairment in the older population the medical research council cognitive function and ageing study
Journal of the American Geriatrics Society, 2011Co-Authors: Chris Fox, Kathryn Richardson, Ian Maidment, George M Savva, Fiona E Matthews, David G Smithard, Simon Coulton, Cornelius KatonaAbstract:Objectives To determine whether the use of medications with possible and definite Anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative. Design A 2-year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993. Setting Community-dwelling and institutionalized participants. Participants Thirteen thousand four participants aged 65 and older. Measurements Baseline use of possible or definite Anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. Results At baseline, 47% of the population used a medication with possible Anticholinergic properties, and 4% used a drug with definite Anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonAnticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite Anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI)=0.03-0.64, P=.03) than not taking Anticholinergics, whereas the use of possible Anticholinergics at baseline was not associated with further decline (0.02, 95% CI=-0.14-0.11, P=.79). Two-year mortality was greater for those taking definite (OR=1.68; 95% CI=1.30-2.16; P Conclusion The use of medications with Anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.
Ian Maidment - One of the best experts on this subject based on the ideXlab platform.
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Anticholinergic and benzodiazepine medication use and risk of incident dementia a uk cohort study
BMC Geriatrics, 2019Co-Authors: Carlota M Grossi, Chris Fox, Kathryn Richardson, Ian Maidment, Antony Arthur, Yoon K Loke, Nicholas Steel, Phyo K Myint, Noll L Campbell, Malaz BoustaniAbstract:Studies suggest that Anticholinergic medication or benzodiazepine use could increase dementia risk. We tested this hypothesis using data from a UK cohort study. We used data from the baseline (Y0), 2-year (Y2) and 10-year (Y10) waves of the Medical Research Council Cognitive Function and Ageing Study. Participants without dementia at Y2 were included (n = 8216). Use of benzodiazepines (including nonbenzodiazepine Z-drugs), Anticholinergics with score 3 (ACB3) and Anticholinergics with score 1 or 2 (ACB12) according to the Anticholinergic Cognitive Burden scale were coded as ever use (use at Y0 or Y2), recurrent use (Y0 and Y2), new use (Y2, but not Y0) or discontinued use (Y0, but not Y2). The outcome was incident dementia by Y10. Incidence rate ratios (IRR) were estimated using Poisson regression adjusted for potential confounders. Pre-planned subgroup analyses were conducted by age, sex and Y2 Mini-Mental State Examination (MMSE) score. Dementia incidence was 9.3% (N = 220 cases) between Y2 and Y10. The adjusted IRRs (95%CI) of developing dementia were 1.06 (0.72, 1.60), 1.28 (0.82, 2.00) and 0.89 (0.68, 1.17) for benzodiazepines, ACB3 and ACB12 ever-users compared with non-users. For recurrent users the respective IRRs were 1.30 (0.79, 2.14), 1.68 (1.00, 2.82) and 0.95 (0.71, 1.28). ACB3 ever-use was associated with dementia among those with Y2 MMSE> 25 (IRR = 2.28 [1.32–3.92]), but not if Y2 MMSE≤25 (IRR = 0.94 [0.51–1.73]). Neither benzodiazepines nor ACB12 medications were associated with dementia. Recurrent use of ACB3 Anticholinergics was associated with dementia, particularly in those with good baseline cognitive function. The long-term prescribing of Anticholinergics should be avoided in older people.
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Anticholinergic medication use and cognitive impairment in the older population the medical research council cognitive function and ageing study
Journal of the American Geriatrics Society, 2011Co-Authors: Chris Fox, Kathryn Richardson, Ian Maidment, George M Savva, Fiona E Matthews, David G Smithard, Simon Coulton, Cornelius KatonaAbstract:PARTICIPANTS: Thirteen thousand four participants aged 65 and older. MEASUREMENTS: Baseline use of possible or definite Anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. RESULTS: At baseline, 47% of the population used a medication with possible Anticholinergic properties, and 4% used a drug with definite Anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonAnticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite Anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI) 50.03‐0.64, P 5.03) than not taking Anticholinergics, whereas the use of possible Anticholinergics at baseline was not associated with further decline (0.02, 95% CI 5 0.14‐0.11, P 5.79). Twoyear mortality was greater for those taking definite (OR 51.68; 95% CI 51.30‐2.16; Po.001) and possible (OR 51.56; 95% CI 51.36‐1.79;Po.001) Anticholinergics. CONCLUSION: The use of medications with Anticholinergic activity increases the cumulative risk of cognitive impairment and mortality. J Am Geriatr Soc 2011.
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Anticholinergic medication use and cognitive impairment in the older population the medical research council cognitive function and ageing study
Journal of the American Geriatrics Society, 2011Co-Authors: Chris Fox, Kathryn Richardson, Ian Maidment, George M Savva, Fiona E Matthews, David G Smithard, Simon Coulton, Cornelius KatonaAbstract:Objectives To determine whether the use of medications with possible and definite Anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative. Design A 2-year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993. Setting Community-dwelling and institutionalized participants. Participants Thirteen thousand four participants aged 65 and older. Measurements Baseline use of possible or definite Anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. Results At baseline, 47% of the population used a medication with possible Anticholinergic properties, and 4% used a drug with definite Anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonAnticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite Anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI)=0.03-0.64, P=.03) than not taking Anticholinergics, whereas the use of possible Anticholinergics at baseline was not associated with further decline (0.02, 95% CI=-0.14-0.11, P=.79). Two-year mortality was greater for those taking definite (OR=1.68; 95% CI=1.30-2.16; P Conclusion The use of medications with Anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.
David G Smithard - One of the best experts on this subject based on the ideXlab platform.
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Anticholinergic medication use and cognitive impairment in the older population the medical research council cognitive function and ageing study
Journal of the American Geriatrics Society, 2011Co-Authors: Chris Fox, Kathryn Richardson, Ian Maidment, George M Savva, Fiona E Matthews, David G Smithard, Simon Coulton, Cornelius KatonaAbstract:PARTICIPANTS: Thirteen thousand four participants aged 65 and older. MEASUREMENTS: Baseline use of possible or definite Anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. RESULTS: At baseline, 47% of the population used a medication with possible Anticholinergic properties, and 4% used a drug with definite Anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonAnticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite Anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI) 50.03‐0.64, P 5.03) than not taking Anticholinergics, whereas the use of possible Anticholinergics at baseline was not associated with further decline (0.02, 95% CI 5 0.14‐0.11, P 5.79). Twoyear mortality was greater for those taking definite (OR 51.68; 95% CI 51.30‐2.16; Po.001) and possible (OR 51.56; 95% CI 51.36‐1.79;Po.001) Anticholinergics. CONCLUSION: The use of medications with Anticholinergic activity increases the cumulative risk of cognitive impairment and mortality. J Am Geriatr Soc 2011.
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Anticholinergic medication use and cognitive impairment in the older population the medical research council cognitive function and ageing study
Journal of the American Geriatrics Society, 2011Co-Authors: Chris Fox, Kathryn Richardson, Ian Maidment, George M Savva, Fiona E Matthews, David G Smithard, Simon Coulton, Cornelius KatonaAbstract:Objectives To determine whether the use of medications with possible and definite Anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative. Design A 2-year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993. Setting Community-dwelling and institutionalized participants. Participants Thirteen thousand four participants aged 65 and older. Measurements Baseline use of possible or definite Anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. Results At baseline, 47% of the population used a medication with possible Anticholinergic properties, and 4% used a drug with definite Anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonAnticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite Anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI)=0.03-0.64, P=.03) than not taking Anticholinergics, whereas the use of possible Anticholinergics at baseline was not associated with further decline (0.02, 95% CI=-0.14-0.11, P=.79). Two-year mortality was greater for those taking definite (OR=1.68; 95% CI=1.30-2.16; P Conclusion The use of medications with Anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.
Chris Fox - One of the best experts on this subject based on the ideXlab platform.
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increasing prevalence of Anticholinergic medication use in older people in england over 20 years cognitive function and ageing study i and ii
Research Square, 2020Co-Authors: Carlota M Grossi, Chris Fox, Kathryn Richardson, George M Savva, Fiona E Matthews, Antony Arthur, Yoon K Loke, Nicholas Steel, Carol Brayne, Louise RobinsonAbstract:Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality, and their use should be limited in older people. Here we estimate the prevalence of Anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability. We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990–1993 (N = 7635) and 2008–2011 (N = 7762). We estimated the prevalence of potent Anticholinergic use (Anticholinergic Cognitive Burden [ACB] score = 3) and average Anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Prevalence of potent Anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2–6.3%) of the older population in 1990–93 to 9.9% (9.3–10.7%) in 2008–11, adjusted odds ratio of 1.90 (95% CI 1.67–2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent Anticholinergics in CFAS II (16.5% [95% CI 12.0–22.3%]). Large increases in the prevalence of the use medication with ‘any’ Anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Use of potent Anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to Anticholinergic side-effects.
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Anticholinergic and benzodiazepine medication use and risk of incident dementia a uk cohort study
BMC Geriatrics, 2019Co-Authors: Carlota M Grossi, Chris Fox, Kathryn Richardson, Ian Maidment, Antony Arthur, Yoon K Loke, Nicholas Steel, Phyo K Myint, Noll L Campbell, Malaz BoustaniAbstract:Studies suggest that Anticholinergic medication or benzodiazepine use could increase dementia risk. We tested this hypothesis using data from a UK cohort study. We used data from the baseline (Y0), 2-year (Y2) and 10-year (Y10) waves of the Medical Research Council Cognitive Function and Ageing Study. Participants without dementia at Y2 were included (n = 8216). Use of benzodiazepines (including nonbenzodiazepine Z-drugs), Anticholinergics with score 3 (ACB3) and Anticholinergics with score 1 or 2 (ACB12) according to the Anticholinergic Cognitive Burden scale were coded as ever use (use at Y0 or Y2), recurrent use (Y0 and Y2), new use (Y2, but not Y0) or discontinued use (Y0, but not Y2). The outcome was incident dementia by Y10. Incidence rate ratios (IRR) were estimated using Poisson regression adjusted for potential confounders. Pre-planned subgroup analyses were conducted by age, sex and Y2 Mini-Mental State Examination (MMSE) score. Dementia incidence was 9.3% (N = 220 cases) between Y2 and Y10. The adjusted IRRs (95%CI) of developing dementia were 1.06 (0.72, 1.60), 1.28 (0.82, 2.00) and 0.89 (0.68, 1.17) for benzodiazepines, ACB3 and ACB12 ever-users compared with non-users. For recurrent users the respective IRRs were 1.30 (0.79, 2.14), 1.68 (1.00, 2.82) and 0.95 (0.71, 1.28). ACB3 ever-use was associated with dementia among those with Y2 MMSE> 25 (IRR = 2.28 [1.32–3.92]), but not if Y2 MMSE≤25 (IRR = 0.94 [0.51–1.73]). Neither benzodiazepines nor ACB12 medications were associated with dementia. Recurrent use of ACB3 Anticholinergics was associated with dementia, particularly in those with good baseline cognitive function. The long-term prescribing of Anticholinergics should be avoided in older people.
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Anticholinergic medication use and cognitive impairment in the older population the medical research council cognitive function and ageing study
Journal of the American Geriatrics Society, 2011Co-Authors: Chris Fox, Kathryn Richardson, Ian Maidment, George M Savva, Fiona E Matthews, David G Smithard, Simon Coulton, Cornelius KatonaAbstract:PARTICIPANTS: Thirteen thousand four participants aged 65 and older. MEASUREMENTS: Baseline use of possible or definite Anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. RESULTS: At baseline, 47% of the population used a medication with possible Anticholinergic properties, and 4% used a drug with definite Anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonAnticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite Anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI) 50.03‐0.64, P 5.03) than not taking Anticholinergics, whereas the use of possible Anticholinergics at baseline was not associated with further decline (0.02, 95% CI 5 0.14‐0.11, P 5.79). Twoyear mortality was greater for those taking definite (OR 51.68; 95% CI 51.30‐2.16; Po.001) and possible (OR 51.56; 95% CI 51.36‐1.79;Po.001) Anticholinergics. CONCLUSION: The use of medications with Anticholinergic activity increases the cumulative risk of cognitive impairment and mortality. J Am Geriatr Soc 2011.
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Anticholinergic medication use and cognitive impairment in the older population the medical research council cognitive function and ageing study
Journal of the American Geriatrics Society, 2011Co-Authors: Chris Fox, Kathryn Richardson, Ian Maidment, George M Savva, Fiona E Matthews, David G Smithard, Simon Coulton, Cornelius KatonaAbstract:Objectives To determine whether the use of medications with possible and definite Anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative. Design A 2-year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993. Setting Community-dwelling and institutionalized participants. Participants Thirteen thousand four participants aged 65 and older. Measurements Baseline use of possible or definite Anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. Results At baseline, 47% of the population used a medication with possible Anticholinergic properties, and 4% used a drug with definite Anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonAnticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite Anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI)=0.03-0.64, P=.03) than not taking Anticholinergics, whereas the use of possible Anticholinergics at baseline was not associated with further decline (0.02, 95% CI=-0.14-0.11, P=.79). Two-year mortality was greater for those taking definite (OR=1.68; 95% CI=1.30-2.16; P Conclusion The use of medications with Anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.
Torgeir Bruun Wyller - One of the best experts on this subject based on the ideXlab platform.
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Anticholinergic drug burden in older people s brain how well is it measured
Basic & Clinical Pharmacology & Toxicology, 2014Co-Authors: Hege Kersten, Torgeir Bruun WyllerAbstract:Concurrent use of several drugs with potential Anticholinergic properties is highly prevalent in the elderly. Methods to determine the overall Anticholinergic drug burden have been developed to estimate the risk of central Anticholinergic adverse effects. The objective of this MiniReview was to critically appraise the clinical utility of the methods used to assess the Anticholinergic drug burden in older people's brain. We evaluated the in vitro method used to measure the Anticholinergic activity in a patient's serum and the four Anticholinergic drug scales: Anticholinergic Risk Scale, Anticholinergic Cognitive Burden, Drug Burden Index and Anticholinergic Drug Scale. Medline searches of the literature from January 1988 to January 2013 were performed. Studies that related Anticholinergic drug burden to central adverse outcomes in elderly people were included, while case reports and studies of single substances were excluded. Despite the consistently reported association between a high Anticholinergic drug burden and negative cognitive and psychomotor outcomes in older patients, there are discrepancies in the literature. Furthermore, no significant cognitive improvements after the Anticholinergic drug burden was reduced have been shown in randomized controlled trials. It is reasonable to question whether the estimated Anticholinergic drug burden can predict the overall brain effects of multiple Anticholinergic agents in older people.