Nina T. Pieper
Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: A meta-analysis
Pieper, Nina T.; Grossi, Carlota M.; Chan, Wei Yee; Loke, Yoon K.; Savva, George M.; Haroulis, Clara; Steel, Nicholas; Fox, Chris; Maidment, Ian D.; Arthur, Antony J.; Myint, Phyo K.; Smith, Toby O.; Robinson, Louise; Matthews, Fiona E.; Brayne, Carol; Richardson, Kathryn
Authors
Carlota M. Grossi
Wei Yee Chan
Yoon K. Loke
George M. Savva
Clara Haroulis
Nicholas Steel
Chris Fox
Ian D. Maidment
Antony J. Arthur
Phyo K. Myint
Toby O. Smith
Louise Robinson
Professor Fiona Matthews F.Matthews@hull.ac.uk
Pro-Vice-Chancellor Research and Enterprise
Carol Brayne
Kathryn Richardson
Abstract
Background: the long-term effect of the use of drugs with anticholinergic activity on cognitive function remains unclear. Methods: we conducted a systematic review and meta-analysis of the relationship between anticholinergic drugs and risk of dementia, mild cognitive impairment (MCI) and cognitive decline in the older population. We identified studies published between January 2002 and April 2018 with ≥12 weeks follow-up between strongly anticholinergic drug exposure and the study outcome measurement. We pooled adjusted odds ratios (OR) for studies reporting any, and at least short-term (90+ days) or long-term (365+ days) anticholinergic use for dementia and MCI outcomes, and standardised mean differences (SMD) in global cognition test scores for cognitive decline outcomes. Statistical heterogeneity was measured using the I2 statistic and risk of bias using ROBINS-I. Results: twenty-six studies (including 621,548 participants) met our inclusion criteria. ‘Any’ anticholinergic use was associated with incident dementia (OR 1.20, 95% confidence interval [CI] 1.09–1.32, I2 = 86%). Short-term and long-term use were also associated with incident dementia (OR 1.23, 95% CI 1.17–1.29, I2 = 2%; and OR 1.50, 95% CI 1.22–1.85, I2 = 90%). ‘Any’ anticholinergic use was associated with cognitive decline (SMD 0.15; 95% CI 0.09–0.21, I2 = 3%) but showed no statistically significant difference for MCI (OR 1.24, 95% CI 0.97–1.59, I2 = 0%). Conclusions: anticholinergic drug use is associated with increased dementia incidence and cognitive decline in observational studies. However, a causal link cannot yet be inferred, as studies were observational with considerable risk of bias. Stronger evidence from high-quality studies is needed to guide the management of long-term use.
Citation
Pieper, N. T., Grossi, C. M., Chan, W. Y., Loke, Y. K., Savva, G. M., Haroulis, C., Steel, N., Fox, C., Maidment, I. D., Arthur, A. J., Myint, P. K., Smith, T. O., Robinson, L., Matthews, F. E., Brayne, C., & Richardson, K. (2020). Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: A meta-analysis. Age and ageing, 49(6), 939-947. https://doi.org/10.1093/ageing/afaa090
Journal Article Type | Review |
---|---|
Acceptance Date | Apr 14, 2020 |
Online Publication Date | Jun 29, 2020 |
Publication Date | Nov 1, 2020 |
Deposit Date | Sep 5, 2024 |
Publicly Available Date | Sep 13, 2024 |
Journal | Age and Ageing |
Print ISSN | 0002-0729 |
Publisher | Oxford University Press |
Peer Reviewed | Peer Reviewed |
Volume | 49 |
Issue | 6 |
Pages | 939-947 |
DOI | https://doi.org/10.1093/ageing/afaa090 |
Keywords | Systematic review; Meta-analysis; Anticholinergics; Dementia; Cognition; Older people |
Public URL | https://hull-repository.worktribe.com/output/4451600 |
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Copyright Statement
© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
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