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Common drugs could increase risk of cognitive decline

Thursday September 3rd 2020

A common class of drugs could be associated with an increased risk of cognitive decline, a US study has claimed.

Researchers found that people who take at least one anticholinergic drug, used for motion sickness, urinary incontinence, overactive bladder, Parkinson’s disease and high blood pressure, are 47% more likely to develop mild cognitive impairment over the following decade than those who do not take them.

Study author Lisa Delano-Wood, of the University of California, San Diego, said: “Our findings suggest that reducing the use of anticholinergic drugs before people develop any cognitive problems may be an important way to prevent the negative consequences of these drugs on thinking skills, especially for people who have an elevated risk of developing Alzheimer’s disease.”

The study, published in Neurology, involved 688 people, whose average age was 74. None had problems with thinking and memory skills at the start of the study and the participants reported if they took any anticholinergic drugs within three months of the start of the study at least once a week for more than six months. They also completed cognitive tests once a year for up to 10 years.

One third of the participants reported taking anticholinergic drugs, with an average of 4.7 anticholinergic drugs taken per person and metoprolol, atenolol, loratadine and bupropion being the most common.

The researchers determined participants’ overall anticholinergic burden based on the number, dosage, and strength of anticholinergic drugs they took.

Of the 230 people who took anticholinergic drugs, 117 people (51%) later developed mild cognitive impairment, compared to 192 people (42%) of the 458 people who did not take the drugs.

After adjusting for depression, number of medications being taken, and history of cardiac problems, the researchers found that those taking at least one anticholinergic drug had a 47% increased risk for developing mild cognitive impairment and individuals with higher overall exposure to anticholinergic drugs had additional increased risk.

The study also found that people with biomarkers for Alzheimer’s disease in their cerebrospinal fluid who also took anticholinergic drugs were four times more likely to later develop mild cognitive impairment compared with people who neither took the drugs nor had the biomarkers.

People who had genetic risk factors for Alzheimer’s disease and took anticholinergic drugs were about 2.5 times as likely to later develop mild cognitive impairment compared with individuals without the genetic risk factors and who did not take them.

Dr Delano-Wood said that 57% of older adults who participated in the study took twice the recommended dosage of anticholinergic drugs, while 18% took at least four times the recommended dosage.

“This is of course concerning and is a potential area for improvement that could possibly lead to a reduction in cases of mild cognitive impairment,” she said.

“It is also a possible target toward a future precision medicine approach because we can more carefully consider and prescribe medications for people depending upon their risk profile for neurodegenerative disorders like Alzheimer’s disease.”

Although only one-third of the participants in this study took anticholinergic medications, when other studies report that up to 70% of older people take them, Dr Delano-Wood said: “These findings are compelling given that meaningful effects of these drugs on cognitive function were detected even though the volunteers in the study were generally very healthy and not taking as many medications as many older adults living in our communities.”

Association of anticholinergic medication and AD biomarkers with incidence of MCI among cognitively normal older adults. Neurology 2 September 2020

https://n.neurology.org/content/early/2020/09/02/WNL.0000000000010643

Tags: Brain & Neurology | Elderly Health | North America | Pharmaceuticals

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