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Public Health.

Adriana Nancy Medeiros Dos Santos1, Natalia Gomes Goncalves2, Alessandra C Goulart3

  • 1University of São Paulo Medical School, São Paulo, Brazil.

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Summary

Anticholinergic burden impacts cognition differently across race and sex. The study found associations with cognitive decline primarily in white and male participants, highlighting the need for personalized approaches.

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Area of Science:

  • Neuroscience
  • Gerontology
  • Pharmacology

Background:

  • Anticholinergic burden is linked to cognitive decline, but racial and sex disparities are understudied.
  • The ELSA-Brasil cohort provides a unique opportunity to examine these differences in a diverse population.

Purpose of the Study:

  • To investigate racial and sex differences in the longitudinal relationship between Anticholinergic Cognitive Burden (ACB) and cognitive decline.
  • To analyze how ACB affects cognitive functions over an eight-year period in a Brazilian cohort.

Main Methods:

  • Prospective cohort study (ELSA-Brasil) with 13,065 participants (aged 35-74).
  • ACB measured using the ACB scale at baseline.
  • Cognitive performance assessed across three waves using memory, verbal fluency, and executive function tests.
  • Linear mixed-effects models analyzed the association between ACB and cognitive decline.

Main Results:

  • ACB was associated with cognitive decline in white participants (global cognition, memory, executive function).
  • In men, ACB correlated with declines in global cognition, memory, executive function, and verbal fluency.
  • No significant association between ACB and cognitive decline was observed in black/brown participants or women.

Conclusions:

  • The impact of ACB on cognitive decline varies significantly by race and sex.
  • Associations were stronger in white and male individuals, underscoring the need to consider these factors in clinical practice.
  • Results emphasize personalized approaches to anticholinergic medication management for cognitive health.