Anticholinergic Medication Burden-Associated Cognitive Impairment in Schizophrenia
Yash B Joshi1, Michael L Thomas1, David L Braff1
1Desert Pacific Mental Illness Research, Education, and Clinical Center, VA San Diego Healthcare System, San Diego (Joshi, Braff, MacDonald, Molina, Light, Sprock); Department of Psychiatry, University of California, San Diego, La Jolla (Joshi, Braff, Swerdlow, Greenwood, MacDonald, Molina, Nungaray, Sprock, M.T. Tsuang, Light); Department of Psychology, Colorado State University, Fort Collins (Thomas); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Nuechterlein, Sugar); Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green); Department of Psychiatry, University of Pennsylvania, Philadelphia (R.C. Gur, R.E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, and Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences and Department of Biomedical Data Science, Stanford University, Stanford, Calif. (Lazzeroni); Sierra Pacific Mental Illness Research, Education, and Clinical Center, VA Health Care System, Palo Alto, Calif. (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D.W. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (Radant, D.W. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research and Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar).
Anticholinergic medication burden significantly impairs cognitive function in schizophrenia patients across all domains. This highlights the need to consider medication side effects when managing schizophrenia and cognitive health.
Area of Science:
- Neuroscience
- Psychiatry
- Pharmacology
Background:
- Many psychotropic medications for schizophrenia have anticholinergic properties.
- Anticholinergic burden is linked to cognitive impairment and dementia risk in healthy individuals.
- Optimizing cognitive outcomes in schizophrenia requires understanding medication's impact.
Purpose of the Study:
- To characterize how anticholinergic medication burden affects cognitive functioning in schizophrenia outpatients.
- To investigate the relationship between anticholinergic burden and cognition across multiple domains.
- To inform treatment decisions and research by clarifying cognitive impacts.
Main Methods:
- Analyzed cross-sectional data from 1,120 schizophrenia/schizoaffective disorder patients.
- Used inferential statistics and structural equation modeling to assess cognition and medication burden.
- Rated prescribed medications using a modified Anticholinergic Cognitive Burden (ACB) scale and assessed cognition via the Penn Computerized Neurocognitive Battery (PCNB).
Main Results:
- Higher ACB scores were significantly associated with worse cognitive performance across all PCNB domains.
- These cognitive deficits remained significant after controlling for demographics, symptoms, and antipsychotic dosage.
- Anticholinergic medication burden impacts multiple cognitive domains in schizophrenia.
Conclusions:
- Anticholinergic medication burden is substantial and common in schizophrenia treatment.
- This burden, from various medication classes, is linked to widespread cognitive impairments.
- Consider anticholinergic burden in schizophrenia treatment and research for better cognitive outcomes.
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