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Use of anticholinergics and the risk of cognitive impairment in an African American population
Open accessAbstract
BACKGROUND: Anticholinergic properties of certain medications often go unrecognized, and are frequently used by the elderly population. Few studies have yet defined the long-term impact of these medications on the incidence of cognitive impairment. METHODS: We report a 6-year longitudinal, observational study, evaluating 1,652 community-dwelling African American subjects over the age of 70 years who were enrolled in the Indianapolis-Ibadan Dementia Project between 2001 and 2007 and who had normal cognitive function at baseline. The exposure group included those who reported the baseline use of possible or definite anticholinergics as determined by the Anticholinergic Cognitive Burden scale. Our main outcome measure was the incidence of cognitive impairment, defined as either dementia or cognitive impairment not dementia, or poor performance on a dementia screening instrument during the follow-up period. RESULTS: At baseline, 53% of the population used a possible anticholinergic, and 11% used a definite anticholinergic. After adjusting for age, gender, educational level, and baseline cognitive performance, the number of definite anticholinergics was associated with an increased risk of cognitive impairment (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.07-1.99; p = 0.02), whereas the number of possible anticholinergics at baseline did not increase the risk (OR 0.96, 95% CI 0.85-1.09; p = 0.55). The risk of cognitive impairment among definite anticholinergic users was increased if they were not carriers of the APOE epsilon4 allele (OR 1.77, 95% CI 1.03-3.05; p = 0.04). CONCLUSIONS: Limiting the clinical use of definite anticholinergics may reduce the incidence of cognitive impairment among African Americans.
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“Previous literature suggests a strong association between anticholinergic use and risk of cognitive decline and dementia (12)(13)(14).”
From Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors (2015) · cites this paper as [12]
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“Another longitudinal study, the Indianapolis-Ibadan dementia project, revealed that number of anticholinergics was associated with an increased risk of cognitive impairment (OR=1.46,CI=1.07-1.99)(12).”
From Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors (2015) · cites this paper as [12]
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Bali, V., Chatterjee, S., Carnahan, R. M., Chen, H., Johnson, M. L., & Aparasu, R. R. (2015) · Psychiatric Services · doi:10.1176/appi.ps.201500011 · Cited by 23
Metadata
- Authors
- Campbell, N. L., Boustani, M. A., Lane, K. A., Gao, S., Hendrie, H., Khan, B. A., Murrell, J. R., Unverzagt, F. W., Hake, A., Smith-Gamble, V., & Hall, K.
- Affiliations
- Regenstrief Institute (US)
- From Wishard Health Services (N.L.C.); Indiana University Center for Aging Research (M.A.B., H.H.); Regenstrief Institute, Inc. (M.A.B., H.H.); Department of Medicine (M.A.B., K.A.L., S.G., B.A.K., A.H.), Indiana University School of Medicine; Departments of Psychiatry (H.H., F.W.U., V.S.-G., K.H.), Pathology and Laboratory Medicine (J.R.M.), and Neurology (A.H.), Indiana University Indianapolis; and Richard L. Roudebush Veterans Administration Medical Center (V.S.-G.), Indianapolis, IN.
- ORCID
- Venue
- Neurology
- Published
- 2010-07-13
- Volume
- 75
- Issue
- 2
- Pages
- 152-159
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC2905930
- OpenAlex
- W2166487292
- Cited by
- 194
- References
- 5
- Citations by year
- 2026: 14 · 2025: 15 · 2024: 10 · 2023: 8 · 2022: 6 · 2021: 21 · 2020: 21 · 2019: 11 · 2018: 16 · 2017: 11 · 2016: 12 · 2015: 14 · 2014: 7 · 2013: 11 · 2012: 7
- FWCI
- 6.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5u01ag024904-10)
- U.S. Public Health Service (R01 AGO9956)
- National Institute on Aging (U01-AG-024904, RC2AG036650, P30AG010133, R01AG023038, R01 AG025688, R01AG026096, R01AG019181, U24AG026395, U24AG021886, AG23038-01A1, R01AG009956)
- National Institute of Nursing Research (U01NR004508)
- National Institute of Neurological Disorders and Stroke (U01NS041588)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- anticholinergic agents, cognitive impairment, dementia, African Americans, older adults, APOE ε4, Anticholinergic Cognitive Burden Scale, adverse drug reactions, community-dwelling older adults
- MeSH terms
- Aged, Aged, 80 and over, Apolipoproteins E, Black or African American, Cognition Disorders, Female, Humans, Longitudinal Studies, Male, Neuropsychological Tests, Risk, Risk Factors, Incidence, Chi-Square Distribution, Odds Ratio, Cholinergic Antagonists
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