Cognitive decline associated with anticholinergics, benzodiazepines, and Z-drugs: findings from The Irish Longitudinal Study on Ageing (TILDA)

Abstract

Aims: To estimate the association between patterns of anticholinergic, benzodiazepine and Z-drug medication use and change in cognitive function in middle-aged and older adults. Methods: This prospective cohort study used data from the first three waves of The Irish Longitudinal Study on Ageing (TILDA), including community-dwelling adults aged ≥50 years followed for up to 4 years (n = 7027). Cognitive function was assessed using the Mini Mental State Examination, animal naming test and word recall tests. Regular medication use was self-reported at baseline and follow-up interviews at 2 and 4 years. Pharmacy dispensing claims for a subset (n = 2905) allowed assessment of medication use between interviews and cumulative dosage. Medication use at consecutive waves of TILDA was analysed in relation to change in cognitive function between waves. Results: Strongly anticholinergic medications (Anticholinergic Cognitive Burden scale 3), benzodiazepines and Z-drugs were reported by 7.3%, 5.8% and 5.1% of participants, respectively, at any time during the study. Adjusting for potential confounders, new anticholinergic use between interviews was associated with change in recall score (−1.09, 95% confidence interval −1.64, −0.53) over 2 years compared to non-use, but not with MMSE (0.07; 95% CI −0.21, 0.34) or animal naming (−0.70; 95% CI −1.43, 0.03). The pharmacy claims analysis was consistent with this finding. Other hypothesised associations were not supported. Conclusions: Except for new use of anticholinergic medications, no other findings supported a risk of cognitive decline over 2-year periods in this middle-aged and older cohort. Patients and prescribers should weigh this potential risk against potential benefits of commencing anticholinergic medications.

Publication DOI: https://doi.org/10.1101/2020.05.09.20095661
Divisions: College of Health & Life Sciences > Aston Pharmacy School
College of Health & Life Sciences > Chronic and Communicable Conditions
College of Health & Life Sciences
Additional Information: This is the peer reviewed version of the following article: Moriarty, F, Savva, GM, Grossi, CM, et al. Cognitive decline associated with anticholinergics, benzodiazepines, and Z‐drugs: findings from The Irish Longitudinal Study on Ageing (TILDA). Br J Clin Pharmacol. 2020. Accepted Author Manuscript, which has been published in final form at https://doi.org/10.1111/bcp.14687.  This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.
Uncontrolled Keywords: Z-drugs,anticholinergic medication,benzodiazepines,cognitive function,pharmacoepidemiology,Pharmacology,Pharmacology (medical)
Publication ISSN: 1365-2125
Full Text Link:
Related URLs: https://bpspubs ... .1111/bcp.14687 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2021-07
Published Online Date: 2020-12-03
Accepted Date: 2020-11-30
Authors: Moriarty, Frank
Savva, George M
Grossi, Carlota M.
Bennett, Kathleen
Fox, Chris
Maidment, Ian (ORCID Profile 0000-0003-4152-9704)
Loke, Yoon K
Steel, Nicholas
Kenny, Rose Anne
Richardson, Kathryn

Download

[img]

Version: Accepted Version

| Preview

[img]

Version: Accepted Version

| Preview

Export / Share Citation


Statistics

Additional statistics for this record