ABSTRACT (with links to relevant sections)
ABSTRACT |
INTRODUCTION |
METHODS |
RESULTS |
DISCUSSION |
CONCLUSIONS |
ARTICLE INFORMATION |
REFERENCES
Importance Many medications have anticholinergic effects. In general, anticholinergic-induced cognitive impairment is considered reversible on discontinuation of anticholinergic therapy. However, a few studies suggest that anticholinergics may be associated with an increased risk for dementia.
Objective To examine whether cumulative anticholinergic use is associated with a higher risk for incident dementia.
Design, Setting, and Participants Prospective population-based cohort study using data from the Adult Changes in Thought study in Group Health, an integrated health care delivery system in Seattle, Washington. We included 3434 participants 65 years or older with no dementia at study entry. Initial recruitment occurred from 1994 through 1996 and from 2000 through 2003. Beginning in 2004, continuous replacement for deaths occurred. All participants were followed up every 2 years. Data through September 30, 2012, were included in these analyses.
Exposures Computerized pharmacy dispensing data were used to ascertain cumulative anticholinergic exposure, which was defined as the total standardized daily doses (TSDDs) dispensed in the past 10 years. The most recent 12 months of use was excluded to avoid use related to prodromal symptoms. Cumulative exposure was updated as participants were followed up over time.
Main Outcomes and Measures Incident dementia and Alzheimer disease using standard diagnostic criteria. Statistical analysis used Cox proportional hazards regression models
adjusted for demographic characteristics, health behaviors, and health status, including comorbidities.
Results The most common anticholinergic classes used were tricyclic antidepressants, first-generation antihistamines, and bladder antimuscarinics. During a mean follow-up of 7.3 years, 797 participants (23.2%) developed dementia (637 of these [79.9%] developed Alzheimer disease). A 10-year cumulative dose-response relationship was observed for dementia and Alzheimer disease (test for trend,
P < .001).
For dementia, adjusted hazard ratios for cumulative anticholinergic use compared with nonuse were 0.92 (95% CI, 0.74-1.16) for TSDDs of 1 to 90; 1.19 (95% CI, 0.94-1.51) for TSDDs of 91 to 365; 1.23 (95% CI, 0.94-1.62) for TSDDs of 366 to 1095; and 1.54 (95% CI, 1.21-1.96) for TSDDs greater than 1095. A similar pattern of results was noted for Alzheimer disease. Results were robust in secondary, sensitivity, and post hoc analyses.
Conclusions and Relevance Higher cumulative anticholinergic use is associated with an increased risk for dementia. Efforts to increase awareness among health care professionals and older adults about this potential medication-related risk are important to minimize anticholinergic use over time.
HOW TO SEE IF YOUR MEDICATION IS INCLUDED AND WHAT YOUR TSDD WOULD BE
The key thing here is the TSDD, or total standardised daily dose. The paper includes a supplement
http://archinte.jamanetwork.com/data/Journals/INTEMED/932778/IOI140138supp1_prod.pdf
which lists medications and the 'minimum effective dose' for each, which counts as the "standardised daily dose", or SDD. Total SDD is over ten years.
You can check that supplement to see if it includes your own medication. As an example, amitriptyline, which many people (me included) take to help with sleep, has a SDD of 10mg.
So for someone taking 20mg (=2 SDDs) every night for ten years:
TSDD = 2 x 365 days x 10 years = 7,330.
That would put it in the highest risk category (TSDD > 1,095), with an increased risk of dementia of 1.5x.
