The impact of anticholinergic burden on the development of mild behavioral impairment
Clio E Franklin1,2, Paul B Rosenberg1, Constantine G Lyketsos1
1Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, Maryland, 21287, USA.
Objective:
Mild Behavioral Impairment (MBI) is a syndrome of late-life-onset persistent neuropsychiatric symptoms. Anticholinergic medication is commonly prescribed in older adults. Both MBI and anticholinergic exposure are associated with increased dementia risk. We sought to understand the association of anticholinergic burden (ACB) with MBI.
Design Setting Participants:
We mapped ratings on the Neuropsychiatric Inventory Questionnaire to the MBI checklist (MBI-C) using an established algorithm to define MBI status in cognitively unimpaired individuals in the National Alzheimer's Coordinating Center database. We then assessed the association between time-varying ACB ratings and risk of incident MBI.
Results:
4865 participants met inclusion criteria and were followed for a mean (SD) of 5.64 (3.92) years. ACB scores ranged from 0-11. 63.3% of participants had a score of 0, 27.7% had a score of 1-2, and 9% had a score of ≥3. Higher maximum total ACB score was associated with a higher likelihood of developing MBI (p=<0.001). When assessed as a time varying covariate, ACB score was associated with incident MBI (HR 1.12, 95% CI 1.05-1.19, p=<0.001). This association remained significant when adjusted for 10-year mortality risk.
Conclusions:
MBI risk should be considered when prescribing anticholinergic medication in older adults.
Insights
Higher anticholinergic burden (ACB) is linked to an increased risk of developing Mild Behavioral Impairment (MBI) in older adults. This highlights the need for caution when prescribing anticholinergic medications due to potential MBI risks.
Area of Science:
- Gerontology
- Neuroscience
- Pharmacology
Background:
- Mild Behavioral Impairment (MBI) is a syndrome characterized by neuropsychiatric symptoms in late life.
- Anticholinergic medications are frequently prescribed to older adults.
- Both MBI and anticholinergic exposure are independently associated with an elevated risk of dementia.
Purpose of the Study:
- To investigate the association between anticholinergic burden (ACB) and the risk of developing incident MBI in older adults.
- To quantify the relationship between cumulative anticholinergic exposure and MBI development.
Main Methods:
- Utilized the National Alzheimer's Coordinating Center database, including cognitively unimpaired individuals.
- Defined MBI status using an algorithm mapping Neuropsychiatric Inventory Questionnaire ratings to the MBI checklist (MBI-C).
- Assessed the association between time-varying ACB scores and incident MBI risk over a mean follow-up of 5.64 years.
Main Results:
- A total of 4865 participants were analyzed.
- Higher maximum ACB scores were significantly associated with an increased likelihood of developing MBI (p<0.001).
- Time-varying ACB scores showed a significant association with incident MBI (HR 1.12, 95% CI 1.05-1.19, p<0.001), even after adjusting for mortality risk.
Conclusions:
- Anticholinergic burden is a significant risk factor for the development of Mild Behavioral Impairment in older adults.
- Clinicians should carefully consider the potential risk of MBI when prescribing anticholinergic medications to this population.
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