Common drugs linked to cognitiveimpairment and possibly to increased risk ofdeath24 June 2011

A large, long-term study confirms that medicationswith anticholinergic activity, which include manydrugs frequently taken by older adults, causecognitive impairment. The research is also the firstto identify a possible link between these drugs -which include over-the-counter and prescriptionsleep aids and incontinence treatments - and riskof death.

The two-year study of the impact of thesemedications on 13,000 men and women aged 65and older is part of the Medical Research Council(UK) Cognitive Function and Ageing Studies(CFAS), a large UK-based longitudinal multi-centerstudy initiative looking at health and cognitivefunction in older adults. Results of the study ofanticholinergics appear June 24, 2011 in anadvanced online publication of the Journal of theAmerican Geriatrics Society.

Anticholinergics affect the brain by blockingacetylcholine, a nervous system neurotransmitter.Over-the-counter products containingdiphenhydramine, sold under various brand namessuch as Benadryl, Dramamine, Excedrin PM,Nytol, Sominex, Tylenol PM, and Unisom, haveanticolinergic activity. Other anticholinergic drugs,such as Paxil, Detrol, Demerol and Elavil areavailable by prescription.

"Our findings make it clear that clinicians need toreview the cumulative anticholinergic burden inpeople presenting with cognitive impairment todetermine if the drugs are causing decline inmental status," said co-author Malaz Boustani,M.D., Regenstrief Institute investigator, IndianaUniversity School of Medicine associate professorof medicine, and research scientist with the IUCenter for Aging Research.

"Physicians should review with older patients all theover-the-counter and prescription drugs they aretaking to determine exposure," said Dr. Boustani ageriatrician who sees patients at Wishard HealthServices' Healthy Aging Brain Center inIndianapolis.

The researchers, led by Chris Fox, M.D., of theUniversity of East Anglia and Carol Brayne, M.D. ofthe University of Cambridge, used theAnticholinergic Cognitive Burden Scale developedby Dr. Boustani and colleagues at the RegenstriefInstitute, Indiana University and in the UnitedKingdom to evaluate the link betweenanticholinergic activity and cognitive decline.

Medications with anticholinergic effects are used formany diseases including hypertension andcongestive heart failure. The study found that olderage, lower income, and greater number of healthconditions increased use of medications withanticholinergic activity. Women were more likely toreport taking anticholinergic medications, due to thegreater number of health conditions reported bywomen than by men. Participants living ininstitutions were more likely to report takinganticholinergic medications.

"We looked at drugs with either moderate andsevere anticholinergic activity. After adjusting forage, sex, baseline mental status, education,income level, number of non-anticholinergicmedications and health conditions, we found thattaking anticholinergic medications was linked tocognitive impairment and for the first time to death,"said study corresponding author Dr. Fox, apsychiatrist. "We need follow-up to determine thedegree to which anticholinergics are beingprescribed for diseases with significant risk of death

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and the impact of that on our findings."

Authors of the study are Chris Fox, M.D., Universityof East Anglia; Carol Brayne, M.D., KathrynRichardson, M.Sc. and George M. Savva, Ph.D,University of Cambridge; Ian D. Maidment, M.A.,Kent and Medway NHS and Social CarePartnership Trust; Fiona E. Matthews, Ph.D.,Medical Research Council Biostatistics Unit; DavidSmithard, M.D., Kent Community Health NHSTrust; Simon Coulton M.Sc., University of Kent;Cornelius Katona, M.D., University College Londonand Malaz Boustani, M.D., M.P.H., RegenstriefInstitute, Indiana University School of Medicine andIU Center for Aging Research.

"The Anticholinergic Medication Use and CognitiveImpairment in the Older Population: The MedicalResearch Council Cognitive Function and AgeingStudy (CFAS)" was funded by the MedicalResearch Council.

"The Medical Research Council invests in cohortstudies like CFAS because they provide vitalclinical information through observation. Suchprojects require long-term commitment to fulfill theirpotential but having supported cohort studies forwell over half a century, MRC funding andcollaborations have made us an international leaderin this field," said Chris Kennard, MBBS, Ph.D.,chairman of the MRC's Neuroscience and MentalHealth Board.

Provided by Indiana University School of Medicine

APA citation: Common drugs linked to cognitive impairment and possibly to increased risk of death (2011,June 24) retrieved 10 April 2015 from http://medicalxpress.com/news/2011-06-common-drugs-linked-cognitive-impairment.html

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