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Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study

Coupland, Carol A.C.; Hill, Trevor; Dening, Tom; Morriss, Richard; Moore, Michael; Hippisley-Cox, Julia

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Authors

CAROL COUPLAND carol.coupland@nottingham.ac.uk
Professor of Medical Statistics

Profile image of TOM DENING

TOM DENING TOM.DENING@NOTTINGHAM.AC.UK
Clinical Professor in Dementia Research

RICHARD MORRISS richard.morriss@nottingham.ac.uk
Professor of Psychiatry and Community Mental Health

Michael Moore

Julia Hippisley-Cox



Abstract

IMPORTANCE Anticholinergic medicines have short-term cognitive adverse effects, but it
is uncertain whether long-term use of these drugs is associated with an increased risk of dementia.

OBJECTIVE To assess associations between anticholinergic drug treatments and risk of dementia in persons 55 years or older.

DESIGN, SETTING, AND PARTICIPANTS This nested case-control study took place in general practices in England that contributed to the QResearch primary care database. The study evaluated whether exposure to anticholinergic drugs was associated with dementia risk in 58 769 patients with a diagnosis of dementia and 225 574 controls 55 years or older matched by age, sex, general practice, and calendar time. Information on prescriptions for 56 drugs with strong anticholinergic properties was used to calculate measures of cumulative anticholinergic drug exposure. Data were analyzed from May 2016 to June 2018.

EXPOSURES The primary exposure was the total standardized daily doses (TSDDs) of anticholinergic drugs prescribed in the 1 to 11 years prior to the date of diagnosis of dementia or equivalent date in matched controls (index date).
MAIN OUTCOMES AND MEASURES Odds ratios (ORs) for dementia associated with cumulative exposure to anticholinergic drugs, adjusted for confounding variables.

RESULTS Of the entire study population (284 343 case patients and matched controls), 179 365 (63.1%) were women, and the mean (SD) age of the entire population was 82.2 (6.8) years. The adjusted OR for dementia increased from 1.06 (95%CI, 1.03-1.09) in the lowest overall anticholinergic exposure category (total exposure of 1-90 TSDDs) to 1.49 (95%CI, 1.44-1.54) in the highest category (>1095 TSDDs), compared with no anticholinergic drug prescriptions in the 1 to 11 years before the index date. There were significant increases in dementia risk for the anticholinergic antidepressants (adjusted OR [AOR], 1.29; 95%CI, 1.24-1.34), antiparkinson drugs (AOR, 1.52; 95%CI, 1.16-2.00), antipsychotics (AOR, 1.70; 95% CI, 1.53-1.90), bladder antimuscarinic drugs (AOR, 1.65; 95%CI, 1.56-1.75), and antiepileptic drugs (AOR, 1.39; 95%CI, 1.22-1.57) all for more than 1095 TSDDs. Results were similar when exposures were restricted to exposure windows of 3 to 13 years (AOR, 1.46; 95%CI, 1.41-1.52) and 5 to 20 years (AOR, 1.44; 95%CI, 1.32-1.57) before the index date for more than 1095 TSDDs. Associations were stronger in cases diagnosed before the age of 80 years. The population-attributable fraction associated with total anticholinergic drug exposure during the 1 to 11 years before diagnosis was 10.3%.

CONCLUSIONS AND RELEVANCE Exposure to several types of strong anticholinergic drugs is associated with an increased risk of dementia. These findings highlight the importance of reducing exposure to anticholinergic drugs in middle-aged and older people.

Citation

Coupland, C. A., Hill, T., Dening, T., Morriss, R., Moore, M., & Hippisley-Cox, J. (2019). Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study. JAMA Internal Medicine, 179(8), 1084-1093. https://doi.org/10.1001/jamainternmed.2019.0677

Journal Article Type Article
Acceptance Date Feb 19, 2019
Online Publication Date Jun 24, 2019
Publication Date Jun 24, 2019
Deposit Date Jun 28, 2019
Publicly Available Date Jun 28, 2019
Journal JAMA Internal Medicine
Print ISSN 2168-6106
Electronic ISSN 2168-6114
Publisher American Medical Association
Peer Reviewed Peer Reviewed
Volume 179
Issue 8
Pages 1084-1093
DOI https://doi.org/10.1001/jamainternmed.2019.0677
Public URL https://nottingham-repository.worktribe.com/output/2237265
Publisher URL https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353
Contract Date Jun 28, 2019