Journal article
A Cohort Study of Anticholinergic Medication Burden and Incident Dementia and Stroke in Older Adults
Journal of general internal medicine : JGIM, Vol.36(6), pp.1629-1637
06/01/2021
DOI: 10.1007/s11606-020-06550-2
PMCID: PMC8175463
PMID: 33754317
Abstract
Background Anticholinergic medications may increase risk of dementia and stroke, but prospective studies in healthy older people are lacking. Objective Compare risk of incident dementia and stroke by anticholinergic burden among initially healthy older people. Design Prospective cohort study. Setting Primary care (Australia and USA). Participants 19,114 community-dwelling participants recruited for the ASPREE trial, aged 70+ years (65+ if US minorities) without major cardiovascular disease, dementia diagnosis, or Modified Mini-Mental State Examination score below 78/100. Measurements Baseline anticholinergic exposure was calculated using the Anticholinergic Cognitive Burden (ACB) score. Dementia was adjudicated using Diagnostic and Statistical Manual of Mental Disorders volume IV criteria, and stroke using the World Health Organization definition. Results At baseline, 15,000 participants (79%) had an ACB score of zero, 2930 (15%) a score of 1-2, and 1184 (6%) a score of >= 3 (indicating higher burden). After a median follow-up of 4.7 years and adjusting for baseline covariates, a baseline ACB score of >= 3 was associated with increased risk of ischemic stroke (adjusted HR 1.58, 95% CI 1.06, 2.35), or dementia (adjusted HR 1.36, 95% CI 1.01, 1.82), especially of mixed etiology (adjusted HR 1.53, 95% CI 1.06, 2.21). Results were similar for those exposed to moderate/highly anticholinergic medications. Limitations Residual confounding and reverse causality are possible. Assessment of dose or duration was not possible. Conclusions High anticholinergic burden in initially healthy older people was associated with increased risk of incident dementia and ischemic stroke. A vascular effect may underlie this association. These findings highlight the importance of minimizing anticholinergic exposure in healthy older people.
Details
- Title: Subtitle
- A Cohort Study of Anticholinergic Medication Burden and Incident Dementia and Stroke in Older Adults
- Creators
- Jessica E. Lockery - Monash UniversityJonathan C. Broder - Monash UniversityJoanne Ryan - Monash UniversityAshley C. Stewart - Monash UniversityRobyn L. Woods - Monash UniversityTrevor T. -J. Chong - Monash UniversityGeoffrey C. Cloud - Monash UniversityAnne Murray - Hennepin Healthcare Research InstituteJason D. Rigby - Monash UniversityRaj Shah - Rush University Medical CenterElsdon Storey - Monash UniversityStephanie A. Ward - UNSW SydneyRory Wolfe - Monash UniversityChristopher M. Reid - Monash UniversityTaya A. Collyer - Monash UniversityMichael E. Ernst - Roy J. and Lucille A. Carver College of MedicineASPREE Investigator Group
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.36(6), pp.1629-1637
- DOI
- 10.1007/s11606-020-06550-2
- PMID
- 33754317
- PMCID
- PMC8175463
- NLM abbreviation
- J Gen Intern Med
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Publisher
- Springer Nature
- Number of pages
- 9
- Grant note
- U01AG029824 / National Cancer Institute at the National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI) Monash University (Australia); Monash University National Institute on Aging; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) Victorian Cancer Agency (Australia) 334047; 1127060 / National Health and Medical Research Council of Australia; National Health and Medical Research Council (NHMRC) of Australia
- Language
- English
- Date published
- 06/01/2021
- Academic Unit
- Family and Community Medicine; Pharmacy Practice and Science
- Record Identifier
- 9984297347602771
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