2011-06-common-drugs-linked-cognitive-impairment.pdf
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Common drugs linked to cognitive impairment and possibly to increased risk of death 24 June 2011 A large, long-term study confirms that medications with anticholinergic activity, which include many drugs frequently taken by older adults, cause cognitive impairment. The research is also the first to identify a possible link between these drugs - which include over-the-counter and prescription sleep aids and incontinence treatments - and risk of death. The two-year study of the impact of these medications on 13,000 men and women aged 65 and older is part of the Medical Research Council (UK) Cognitive Function and Ageing Studies (CFAS), a large UK-based longitudinal multi-center study initiative looking at health and cognitive function in older adults . Results of the study of anticholinergics appear June 24, 2011 in an advanced online publication of the Journal of the American Geriatrics Society. Anticholinergics affect the brain by blocking acetylcholine, a nervous system neurotransmitter. Over-the-counter products containing diphenhydramine, sold under various brand names such as Benadryl, Dramamine, Excedrin PM, Nytol, Sominex, Tylenol PM, and Unisom, have anticolinergic activity. Other anticholinergic drugs, such as Paxil, Detrol, Demerol and Elavil are available by prescription. "Our findings make it clear that clinicians need to review the cumulative anticholinergic burden in people presenting with cognitive impairment to determine if the drugs are causing decline in mental status," said co-author Malaz Boustani, M.D., Regenstrief Institute investigator, Indiana University School of Medicine associate professor of medicine, and research scientist with the IU Center for Aging Research. "Physicians should review with older patients all the over-the-counter and prescription drugs they are taking to determine exposure," said Dr. Boustani a geriatrician who sees patients at Wishard Health Services' Healthy Aging Brain Center in Indianapolis. The researchers, led by Chris Fox, M.D., of the University of East Anglia and Carol Brayne, M.D. of the University of Cambridge, used the Anticholinergic Cognitive Burden Scale developed by Dr. Boustani and colleagues at the Regenstrief Institute, Indiana University and in the United Kingdom to evaluate the link between anticholinergic activity and cognitive decline. Medications with anticholinergic effects are used for many diseases including hypertension and congestive heart failure. The study found that older age, lower income, and greater number of health conditions increased use of medications with anticholinergic activity. Women were more likely to report taking anticholinergic medications, due to the greater number of health conditions reported by women than by men. Participants living in institutions were more likely to report taking anticholinergic medications. "We looked at drugs with either moderate and severe anticholinergic activity. After adjusting for age, sex, baseline mental status, education, income level, number of non-anticholinergic medications and health conditions, we found that taking anticholinergic medications was linked to cognitive impairment and for the first time to death," said study corresponding author Dr. Fox, a psychiatrist. "We need follow-up to determine the degree to which anticholinergics are being prescribed for diseases with significant risk of death 1 / 2
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Transcript of 2011-06-common-drugs-linked-cognitive-impairment.pdf
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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