Use of medications with anticholinergic properties and cognitive function in a young-old community sample

To examine whether anticholinergic medications have effects on the level of cognitive function or cognitive decline in persons in their early to mid 60s.

A randomly selected community-based sample of 2058 persons aged 60-64 at baseline was interviewed twice over four years. Anticholinergic medication use was determined from self-report medication data using the Anticholinergic Drug Scale. Cognition was assessed with the California Verbal Learning Test I (one trial), Digits Backwards, the Symbol Digit Modalities Test, the Mini-Mental State Exam and simple and choice reaction time. Persons meeting criteria for Mild Cognitive Impairment were identified in a clinical substudy. Mixed models adjusting for age, sex, self-rated depression and physical health, and total number of medications were used to analyse the data.

There was a significant main effect of anticholinergic group averaged across time for the Symbol Digits Modalities Test with poorer performance among anticholinergic medication users. Main effects for the other cognitive tests and mild cognitive impairment were non-significant. No time by anticholinergic group interactions were significant.

This study suggests that exposure to anticholinergic medication is associated with lower level of complex attention in the young-old, but not with greater cognitive decline over time. Although the clinical significance of this is not clear, caution should be taken when prescribing medications with anticholinergic effects to older persons.