Journal article
Anticholinergic burden and risk of cognitive impairment in elderly nursing home residents with depression
Research in social and administrative pharmacy, Vol.16(3), pp.329-335
03/2020
DOI: 10.1016/j.sapharm.2019.05.020
PMID: 31182419
Abstract
Although the adverse cognitive effects of anticholinergic medications in the elderly are well-documented, little is known regarding the cognitive impact of anticholinergics among nursing home residents with depression.
This study examined the risk of mild-to-moderate cognitive impairment due to anticholinergic burden among elderly nursing home residents with depression.
A population-based nested case-control study was conducted using Minimum Data Set (MDS)-linked Medicare data where the base cohort included patients ≥ 65 years with depression who had intact cognition (MDS Cognition score of 0 or 1) and no dementia. Cases were identified as those who had mild-to-moderate cognition (MDS Cognition score of 2–4). Each case was matched on age and sex to one control using incidence density sampling. The study evaluated cumulative anticholinergic burden (defined as score of 3 or more) within 30, 60 and 90 days preceding the event date based on the Anticholinergic Drug Scale (ADS). Conditional logistic regression model stratified on matched case-control sets was performed to evalaute cognitive impairment due to cumulative anticholinergic burden after controlling for other risk factors.
The study sample included 3707 cases with mild-to-moderate cognition and 3707 matched controls with intact cognition. Bivariate analysis showed significant association between cumulative anticholinergic exposure and cognitive impairment (Odds Ratio [OR], 1.15; 95% Confidence Interval [CI],1.04–1.30); after controlling for potential risk factors, cumulative anticholinergic exposure 30 days preceding the event was no longer associated with cognitive impairment, (aOR, 1.07; 95% CI, 0.95–1.21). However, the odds of cognitive impairment increased with cumulative anticholinergic exposure 60 days (aOR 1.16; 1.04–1.30) and 90 days (aOR 1.28; 1.14–1.44) before the event date.
Cumulative anticholinergic use for prolonged exposure periods was associated with modestly increased risk of cognitive impairment in elderly residents with depression who had intact cognition. The findings suggest the need to be cautious when prescribing multiple anticholinergic drugs in residents, including those with intact cognition.
•Cumulative anticholinergic exposure 30 days preceding the event was not associated with cognitive impairment.•The risk of cognitive impairment increased with cumulative anticholinergic (score ≥ 3) 60 and 90 days of exposure.•The findings remained consistent with the Anticholinergic Cognitive Burden scale.
Details
- Title: Subtitle
- Anticholinergic burden and risk of cognitive impairment in elderly nursing home residents with depression
- Creators
- Satabdi Chatterjee - Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USAVishal Bali - Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USARyan M Carnahan - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USAHua Chen - Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USAMichael L Johnson - Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USARajender R Aparasu - Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA
- Resource Type
- Journal article
- Publication Details
- Research in social and administrative pharmacy, Vol.16(3), pp.329-335
- DOI
- 10.1016/j.sapharm.2019.05.020
- PMID
- 31182419
- NLM abbreviation
- Res Social Adm Pharm
- ISSN
- 1551-7411
- eISSN
- 1934-8150
- Publisher
- Elsevier Inc
- Grant note
- DOI: 10.13039/100000133, name: Agency for Healthcare Research and Quality, award: R01HS021264)
- Language
- English
- Date published
- 03/2020
- Academic Unit
- Epidemiology; Injury Prevention Research Center
- Record Identifier
- 9983996198702771
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