The longitudinal association between anticholinergic burden and cognitive-functional decline among older adults

Long-term use of medications with anticholinergic properties has been associated with cognitive and functional decline among older adults, yet these measures are typically assessed in isolation-potentially overlooking their interrelated nature. This study investigated the longitudinal association between anticholinergic burden and integrated cognitive-functional measures in older adults.

Participants were drawn from S.AGES (France, 2009-2012). The total daily anticholinergic burden was assessed using the Anticholinergic Burden Scale (ACB) and the Anticholinergic and Sedative Burden Catalogue (ACSBC). We combined the Mini-Mental State Examination (MMSE) with basic activities of daily living (BADLs), with instrumental activities of daily living (IADLs) or with both. Exploratory factor analyses (EFAs) and confirmatory factor analyses (CFAs) were conducted to explore dimensionality and model fit. The associations between the total burden and outcomes were estimated using generalized linear mixed models (GLMMs).

Among 983 participants, a higher total daily ACB score was associated with poorer MMSE-BADLs-IADLs performance (OR = 1.25; 95% CI = [1.06-1.47]; p = 0.004) and MMSE-IADLs (OR = 1.56; 95% CI = [1.30-1.88]; p < 0.001). Higher ACSBC scores showed similar associations with the MMSE-BADLs-IADLs (OR = 1.23; 95% CI = [1.08-1.40]; p < 0.001) and MMSE-IADLs (OR = 1.40; 95% CI = [1.16-1.70]; p < 0.001). The three cognitive-functional measures showed high internal consistency with comparative fit indexes (CFIs) of 0.9 and 0.95 and root mean squared error of approximations (RMSEAs) < 0.08, supporting a one-factor model.

Our findings, based on combined measures in assessing cognitive-functional decline in older adults, support incorporating anticholinergic burden assessment into routine care, particularly for patients aged ≥85 or those with CNS diseases and depression.