The Impact of Anticholinergic Burden on the Development of Mild Behavioral Impairment
Clio E Franklin1, Paul B Rosenberg2, Constantine G Lyketsos2
1Department of Psychiatry and Behavioral Sciences (CEF, PBR, CGL, JML), Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Psychiatry (CEF), Mass General Brigham, Boston, MA 02114.
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 to 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 1.07, 95% CI 1.02-1.14, p = 0.010). This association remained significant when adjusted for 10-year mortality risk, age, sex, education, and race.
Conclusions:
MBI risk should be considered when prescribing anticholinergic medication in older adults.
Insights
Older adults taking anticholinergic medications have an increased risk of developing mild behavioral impairment (MBI). Higher anticholinergic burden (ACB) is significantly associated with a greater likelihood of incident MBI.
Area of Science:
- Gerontology
- Neuroscience
- Pharmacology
Background:
- Mild behavioral impairment (MBI) is a syndrome characterized by persistent neuropsychiatric symptoms in late life.
- Anticholinergic medications are frequently prescribed for older adults.
- Both MBI and exposure to anticholinergic drugs are linked to an elevated risk of dementia.
Purpose of the Study:
- To investigate the association between anticholinergic burden (ACB) and the risk of developing mild behavioral impairment (MBI) in older adults.
Main Methods:
- Utilized the National Alzheimer's Coordinating Center database, including cognitively unimpaired individuals.
- Defined MBI status by mapping Neuropsychiatric Inventory Questionnaire ratings to the MBI checklist (MBI-C).
- Assessed the association between time-varying ACB scores and the incidence of MBI.
Main Results:
- A total of 4865 participants were followed for an average of 5.64 years.
- Higher maximum ACB scores were significantly associated with an increased likelihood of developing MBI (p ≤0.001).
- ACB score was independently associated with incident MBI (HR 1.07, 95% CI 1.02-1.14, p = 0.010), even after adjusting for mortality risk, age, sex, education, and race.
Conclusions:
- The findings highlight a significant association between anticholinergic burden and the risk of mild behavioral impairment.
- Prescribers should consider the potential risk of MBI when prescribing anticholinergic medications to older adults.
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