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Detailed Cognitive Function and Use of Drugs with Anticholinergic Properties in Older People

A Community-Based Cross-Sectional Study

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Abstract

Background

Many potentially inappropriate drugs prescribed to older people have anticholinergic properties and may therefore be harmful. Drugs with anticholinergic properties (DAPs) are associated with cognitive decline.

Objective

Our aim was to study the profile of various cognitive functions related to current use of DAPs.

Methods

A cross-sectional study was conducted in Helsinki, Finland, and included 400 home-dwelling individuals aged 75–90 years without major clinical dementia but with a history of stable atherosclerotic disease who were participants of the DEBATE (Drugs and Evidence-Based Medicine in the Elderly) study. The cognition of the users (n = 295) and non-users (n = 105) of DAPs was measured with the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) test battery.

Results

Use of DAPs was statistically significantly associated with a low score in verbal fluency, in naming, and on the Mini-Mental State Examination (MMSE). In the logistic regression analysis, the difference remained for low verbal fluency (odds ratio [OR] 1.84, 95 % CI 1.02–3.32; p = 0.044) and naming (OR 1.81, 95 % CI 1.09–3.00; p = 0.021) but not for MMSE score after adjusting for age, sex and education.

Conclusions

Performances for verbal fluency and naming were poorer in DAP users than in non-users, suggesting a possible impairment of executive functioning and semantic memory. The dimensions of the CERAD test assessing episodic memory—the subtests that are the most sensitive in terms of detecting early Alzheimer’s disease—did not show differences between users and non-users of DAPs.

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References

  1. Ott A, Bertelera MM, van Harskamp F, et al. Prevalence of Alzheimer’s disease and vascular dementia: association with education. The Rotterdam study. BMJ. 1995;310(6985):970–3.

    Article  PubMed  CAS  Google Scholar 

  2. Pitkälä KH, Strandberg TE, Tilvis RS. Is it possible to reduce polypharmacy in the elderly? Drugs Aging. 2001;18(2):143–9.

    Article  PubMed  Google Scholar 

  3. Lechevallier-Michel N, Molimard M, Dartigues JF, et al. Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID study. Br J Clin Pharmacol. 2005;59(2):143–51.

    Article  PubMed  Google Scholar 

  4. Ancelin M, Artero S, Portet F, et al. Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ. 2006;332(7539):455–9.

    Article  PubMed  Google Scholar 

  5. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5(4):345–51.

    Article  PubMed  Google Scholar 

  6. Tune L, Carr S, Hoag E, et al. Anticholinergic effects of drugs commonly prescribed for the elderly: potential means for assessing risk of delirium. Am J Psychiatry. 1992;149(10):1393–4.

    PubMed  CAS  Google Scholar 

  7. Uusvaara J, Pitkala KH, Tienari PJ, et al. Association between anticholinergic drugs and apolipoprotein E ε4 allele and poorer cognitive function in older cardiovascular patients: a cross-sectional study. J Am Geriatr Soc. 2009;57(3):427–31.

    Article  PubMed  Google Scholar 

  8. Carrière I, Fourrier-Reglat A, Dartigues JF, et al. Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study. Arch Intern Med. 2009;169(14):1317–24.

    Article  PubMed  Google Scholar 

  9. Morris JC, Heyman A, Mohs RC, et al. The Consortium to Establish a Registry for Alzheimer’s disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology. 1989;39(9):1159–65.

    Article  PubMed  CAS  Google Scholar 

  10. Sotaniemi M, Pulliainen V, Hokkanen L, et al. CERAD-neuropsychological battery in screening mild Alzheimer’s disease. Acta Neurol Scand. 2012;125:16–23.

    Article  PubMed  CAS  Google Scholar 

  11. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.

    Article  PubMed  CAS  Google Scholar 

  12. Mulsant BH, Pollock BG, Kirshner M, et al. Serum anticholinergic activity in a community-based sample of older adults. Arch Gen Psychiatry. 2003;60:198–203.

    Article  PubMed  CAS  Google Scholar 

  13. Brébion G, Bressan RA, Amador X, et al. Medications and verbal memory impairment in schizophrenia: the role of anticholinergic drugs. Psychol Med. 2004;34(2):369–74.

    Article  PubMed  Google Scholar 

  14. Bottiggi KA, Salazar JC, Yu L, et al. Long-term cognitive impact of anticholinergic medications in older adults. Am J Geriatr Psychiatry. 2006;14(11):980–4.

    Article  PubMed  Google Scholar 

  15. Cao YJ, Mager DE, Simonsick EM, et al. Physical and cognitive performance and burden of anticholinergics, sedatives and ACE inhibitors in older women. Clin Pharmacol Ther. 2008;83(3):422–9.

    Article  PubMed  CAS  Google Scholar 

  16. Han L, Agostini JV, Allore HG. Cumulative anticholinergic exposure is associated with poor memory and executive function in older men. J Am Geriatr Soc. 2008;56(12):2203–10.

    Article  PubMed  Google Scholar 

  17. Cancelli I, Gigli GL, Piani A, et al. Drugs with anticholinergic properties as a risk factor for cognitive impairment in elderly people: a population-based study. J Clin Psychopharmacol. 2008;28(6):654–9.

    Article  PubMed  Google Scholar 

  18. Campbell N, Boustani M, Limbil T, et al. The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging. 2009;4:225–33.

    PubMed  Google Scholar 

  19. Strandberg TE, Pitkala KH, Berglind S, et al. Multifactorial cardiovascular disease prevention in patients aged 75 and older: a randomized controlled trial: Drugs and Evidence Based Treatment in the Elderly (DEBATE) Study. Am Heart J. 2001;142(2):945–51.

    Article  PubMed  CAS  Google Scholar 

  20. Strandberg TE, Pitkala KH, Berglind S, et al. Possibilities of multifactorial cardiovascular disease prevention in patients aged 75 and older: a randomized, controlled trial. Drugs and Evidence-Based Treatment in the Elderly (DEBATE) Study. Eur Heart J. 2003;24(13):1216–22.

    Article  PubMed  Google Scholar 

  21. Wenham PR, Price WH, Blandell G. Apolipoprotein E genotyping by one-stage PCR. Lancet. 1991;337(8750):1158–9.

    Article  PubMed  CAS  Google Scholar 

  22. Graham NL, Emery T, Hodges JR. Distinctive cognitive profiles in Alzheimer’s disease and subcortical vascular dementia. J Neurol Neurosurg Psychiatry. 2004;75(1):61–71.

    PubMed  CAS  Google Scholar 

  23. Salthouse TA. Relations between cognitive abilities and measures of executive functioning. Neuropsychology. 2005;19(4):532–45.

    Article  PubMed  Google Scholar 

  24. Bentham PW, Jones S, Hodges JR. A comparison of semantic memory in vascular dementia and dementia of Alzheimer’s type. Int J Geriatr Psychiatry. 1997;12(5):575–80.

    Article  PubMed  CAS  Google Scholar 

  25. Mack WJ, Freed DM, Williams BW, et al. Boston Naming Test: shortened versions for use in Alzheimer’s disease. J Gerontol. 1992;47(3):154–8.

    Article  Google Scholar 

  26. Vogel A, Gade A, Stokholm J, Waldemar G. Semantic memory impairment in the earliest phases of Alzheimer’s disease. Dement Geriatr Cogn Disord. 2005;19(2–3):75–81.

    Article  PubMed  Google Scholar 

  27. Greene JD, Baddley AD, Hodges JR. Analysis of the episodic memory deficit in early Alzheimer’s disease: evidence from the doors and people test. Neuropsychologia. 1996;34(6):537–51.

    Article  PubMed  CAS  Google Scholar 

  28. Budson AE, Wolk DA, Chong H, et al. Episodic memory in Alzheimer’s disease: separating response bias from discrimination. Neuropsychologia. 2006;44(12):2222–32.

    Article  PubMed  Google Scholar 

  29. Ravens J. Vascular changes in human senile brain. Adv Neurol. 1978;20:487–501.

    PubMed  CAS  Google Scholar 

  30. Abbott N, Rönnbäck L, Hansson E. Astrocyte-endothelial interactions at the blood–brain barrier. Nat Rev Neurosci. 2006;7(1):41–53.

    Article  PubMed  CAS  Google Scholar 

  31. Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly people. J R Soc Med. 2000;93:457–62.

    PubMed  CAS  Google Scholar 

  32. Beers MH, Ouslander JG, Rollinger I, et al. Explicit criteria for determining potentially inappropriate medication use in nursing home residents. Arch Intern Med. 1991;151:1825–32.

    Article  PubMed  CAS  Google Scholar 

  33. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arc Intern Med. 1997;157:1531–6.

    Article  CAS  Google Scholar 

  34. Chutka D, Takahashi P, Hoel R. Inappropriate medications for elderly patients. Mayo Clin Proc. 2004;79:122–39.

    Article  PubMed  CAS  Google Scholar 

  35. Herbison P, Hay-Smith J, Ellis G, et al. Effectiveness of anticholinergic drugs compared with placebo in the treatment of overactive bladder: systematic review. BMJ. 2003;326:841–4.

    Article  PubMed  CAS  Google Scholar 

  36. Liu H, Farley J. Effects of first and second generation antihistamines on muscarinic induced mucus gland cell ion transport. BMC Pharmacol. 2005;5:8.

    Article  PubMed  Google Scholar 

  37. DeMaagd G, Geibig J. An overview of overactive bladder and its pharmacological management with a focus on anticholinergic drugs. P&T. 2006;31:462–71.

    Google Scholar 

  38. Seale P. Anticholinergic bronchodilatators. Aust Prescr. 2003;26:33–5.

    Google Scholar 

  39. Tandon R, Taylor S, Quardo J, et al. The cholinergic system in schizophrenia reconsidered: anticholinergic modulation of sleep and symptom profiles. Neuropsychopharmacology. 1999;21:189–202.

    Article  Google Scholar 

  40. Shiraishi M, Minami K, Uezono Y, et al. Inhibition by tramadol of muscarinic receptor-induced responses in cultured adrenal medullary cells and in xenopus laevis oocytes. JPET. 2001;299:255–60.

    CAS  Google Scholar 

  41. Saito M, Shibata O, Yamaguchi M, et al. Metoclopramide causes airway smooth muscle relaxation through inhibition of muscarinic M3 receptor in the rat trachea. Anesth Analg. 2004;98:325–9.

    Google Scholar 

  42. Isah A, Rawlins M, Bateman D. The pharmacokinetics and effects of prochlorperazine in elderly female volunteers. Oxf J. 1991;21:27–31.

    Google Scholar 

  43. Kay G, Abou-Donia M, Messer W, et al. Antimuscarinic drugs for overactive bladder and their potential effects on cognitive function in older patients. JAGS. 2005;53:2195–201.

    Article  Google Scholar 

  44. Cechin EM, Quevedo J, Barichello T, et al. Dose-related effects of propericiazine in rats. Braz J Med Biol Res. 2003;36:227–31.

    Article  PubMed  CAS  Google Scholar 

  45. Minami K, Yasuhito U, Yoichi U. Pharmacological aspects of the effects of tramadol on G-protein coupled receptors. J Pharmacol Sci. 2007;103:253–60.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Details of contributors: conception and design—J.U., K.H.P., R.S.T. and T.E.S.; acquisition, analysis and interpretation of data—J.U., K.H.P., H.K. and T.E.S.; drafting the article or revising it critically for important intellectual content—J.U., K.H.P., H.K., R.S.T. and T.E.S.; final approval of the version to be submitted—J.U., K.H.P., H.K., R.S.T. and T.E.S.; and T.E.S. is the guarantor.

Conflict of interest

All authors declare that there are no conflicts of interest, financial or personal, of any kind. The sponsor had no role in study design and conducting the study; collection, management, analysis and interpretation of data; preparation, writing of the report, review, approval of the manuscript or decision to submit the paper for publication. The authors’ work was independent of the funders.

Author information

Authors and Affiliations

  1. Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland

    Juho Uusvaara, Kaisu H. Pitkala & Hannu Kautiainen

  2. Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland

    Juho Uusvaara, Kaisu H. Pitkala & Hannu Kautiainen

  3. Kauniala Hospital for Disabled War Veterans, Kylpyläntie 19, 02700, Kauniainen, Finland

    Juho Uusvaara

  4. Unit of General Internal Medicine and Geriatrics, Helsinki University Hospital, Helsinki, Finland

    Reijo S. Tilvis

  5. Department of Medicine, Geriatric Clinic, University of Helsinki and University Hospital, Helsinki, Finland

    Timo E. Strandberg

  6. Institute of Health Sciences/Geriatrics, University Hospital and Health Center of Oulu, Oulu, Finland

    Timo E. Strandberg

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  1. Juho Uusvaara
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  2. Kaisu H. Pitkala
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  3. Hannu Kautiainen
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  5. Timo E. Strandberg
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Correspondence to Juho Uusvaara.

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Uusvaara, J., Pitkala, K.H., Kautiainen, H. et al. Detailed Cognitive Function and Use of Drugs with Anticholinergic Properties in Older People. Drugs Aging 30, 177–182 (2013). https://doi.org/10.1007/s40266-013-0055-2

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