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Effects of Anticholinergic Drugs on Verbal Episodic Memory Function in the Elderly

A Retrospective, Cross-Sectional Study

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Abstract

Background

An increasing number of medications that are frequently prescribed to elderly patients have been identified as having weak but definite anticholinergic properties. Few epidemiological studies have evaluated the impact of these drugs on verbal episodic memory using sensitive and specific neuropsychological testing in an elderly population presenting with cognitive impairment.

Objectives

The aim of this study was to assess the effect of drugs with anticholinergic properties on verbal episodic memory function in elderly patients presenting for memory evaluation.

Study Design

We performed a retrospective, cross-sectional study that included 134 consecutive elderly outpatients who attended the daycare memory unit of Centre Hospitalier Sud, Lyon, France. We searched the MEDLINE database (1973–2008) to identify drugs with anticholinergic properties. All drugs with well known anticholinergic activity, mild reported anticholinergic effects or in vitro anticholinergic activity were included in the study.

Measurements

We used the Free and Cued Selective Reminding (FCSR) test to evaluate verbal episodic memory.

Results

The mean±SD number of drugs with anticholinergic properties taken by the subjects was 0.64±0.82. Fifty percent of the subjects (n = 67) had a prescription for at least one drug with anticholinergic properties and 16% (n = 21) had a prescription for two or more. Drugs with anticholinergic properties most frequently prescribed in our cohort were cardiovascular (furosemide, hydrochlorothiazide, digoxin), antidepressant (paroxetine, sertraline, fluoxetine) and antispasmodic (oxybutynin chloride) drugs. The number of drugs with anticholinergic properties that subjects were taking was associated with reduced performance on tasks that assessed verbal memory (p < 0.05). Neuropsychological test batteries revealed a significant unfavourable effect of use of drugs with anticholinergic activity on episodic verbal memory. Tests evaluating other cognitive functions were not affected by use of drugs with anticholinergic activity. These associations remained following multivariate analysis adjusting for age, sex, education level, number of anticholinergic drugs, number of co-morbidities, diagnosis, behavioural symptoms and depressive symptoms.

Conclusion

Clinicians should assess the current use of drugs with anticholinergic properties in the elderly, particularly in patients presenting for memory evaluation. In such cases, use of other therapeutic alternatives should be considered.

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References

  1. WHO. World Health Organization statistical information system [online]. Available from URL: http://www.who.int/whosis/en/index.html [Accessed 2008 Nov]

  2. Ramaroson H, Helmer C, Barberger-Gateau P, et al. Prevalence of dementia and Alzheimer’s disease among subjects aged 75 years or over: updated results of the PAQUID cohort. Rev Neurol (Paris) 2003 Apr; 159(4): 405–11

    CAS  Google Scholar 

  3. DeKosky ST. Neurobiology and molecular biology of Alzheimer’s disease. Rev Neurol 2002 Oct 16–31; 35(8): 752–60

    PubMed  CAS  Google Scholar 

  4. Mulsant BH, Pollock BG, Kirshner M, et al. Serum anticholinergic activity in a community-based sample of older adults: relationship with cognitive performance. Arch Gen Psychiatry 2003 Feb; 60(2): 198–203

    Article  PubMed  CAS  Google Scholar 

  5. Rudolph JL, Salow MJ, Angelini MC, et al. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med 2008 Mar 10; 168(5): 508–13

    Article  PubMed  Google Scholar 

  6. Tune LE. Serum anticholinergic activity levels and delirium in the elderly. Semin Clin Neuropsychiatry 2000 Apr; 5(2): 149–53

    PubMed  CAS  Google Scholar 

  7. Masoudi FA, Baillie CA, Wang Y, et al. The complexity and cost of drug regimens of older patients hospitalized with heart failure in the United States, 1998–2001. Arch Intern Med 2005 Oct 10; 165(18): 2069–76

    Article  PubMed  Google Scholar 

  8. Lechevallier-Michel N, Molimard M, Dartigues JF, et al. Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID study. Br J Clin Pharmacol 2005 Feb; 59(2): 143–51

    Article  PubMed  Google Scholar 

  9. Cao YJ, Mager DE, Simonsick EM, et al. Physical and cognitive performance and burden of anticholinergics, sedatives, and ACE inhibitors in older women. Clin Pharmacol Ther 2008 Mar; 83(3): 422–9

    Article  PubMed  CAS  Google Scholar 

  10. Ancelin ML, Artero S, Portet F, et al. Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ 2006 Feb 25; 332(7539): 455–9

    Article  PubMed  Google Scholar 

  11. Cancelli I, Valentinis L, Merlino G, et al. Drugs with anticholinergic properties as a risk factor for psychosis in patients affected by Alzheimer’s disease. Clin Pharmacol Ther 2008 Jul; 84(1): 63–8

    Article  PubMed  CAS  Google Scholar 

  12. Uusvaara J, Pitkala KH, Tienari PJ, et al. Association between anticholinergic drugs and apolipoprotein E epsilon4 allele and poorer cognitive function in older cardiovascular patients: a cross-sectional study. J Am Geriatr Soc 2009 Mar; 57(3): 427–31

    Article  PubMed  Google Scholar 

  13. Feinberg M. The problems of anticholinergic adverse effects in older patients. Drugs Aging 1993 Jul–Aug; 3(4): 335–48

    Article  PubMed  CAS  Google Scholar 

  14. Rudd KM, Raehl CL, Bond CA, et al. Methods for assessing drug-related anticholinergic activity. Pharmacotherapy 2005 Nov; 25(11): 1592–601

    Article  PubMed  CAS  Google Scholar 

  15. Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly people. J R Soc Med 2000 Sep; 93(9): 457–62

    PubMed  CAS  Google Scholar 

  16. Lu CJ, Tune LE. Chronic exposure to anticholinergic medications adversely affects the course of Alzheimer disease. Am J Geriatr Psychiatry 2003 Jul–Aug; 11(4): 458–61

    PubMed  Google Scholar 

  17. Thienhaus OJ, Allen A, Bennett JA, et al. Anticholinergic serum levels and cognitive performance. Eur Arch Psychiatry Clin Neurosci 1990; 240(1): 28–33

    Article  PubMed  CAS  Google Scholar 

  18. Agence Nationale d’Accréditation et d’Évaluation en Santé (ANAES). Recommandations pratiques pour le diagnostic de la maladie d’alzheimer. Paris: ANAES, 2000 [online]. Available from URL: http://www.unaformec.org/CDRMG/cederom_ol/recos/anaes/alzhe_00.pdf [Accessed 2008 Nov]

    Google Scholar 

  19. Minzenberg MJ, Poole JH, Benton C, et al. Association of anticholinergic load with impairment of complex attention and memory in schizophrenia. Am J Psychiatry 2004 Jan; 161(1): 116–24

    Article  PubMed  Google Scholar 

  20. Chew ML, Mulsant BH, Pollock BG, et al. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 2008 May 26; 56(7): 1333–41

    Article  PubMed  Google Scholar 

  21. Snyder S, Greenberg D, Yamamura HI. Antischizophrenic drugs and brain cholinergic receptors: affinity for muscarinic sites predicts extrapyramidal effects. Arch Gen Psychiatry 1974 Jul; 31(1): 58–61

    Article  PubMed  CAS  Google Scholar 

  22. Richelson E. Pharmacology of antidepressants: characteristics of the ideal drug. Mayo Clin Proc 1994 Nov; 69(11): 1069–81

    Article  PubMed  CAS  Google Scholar 

  23. Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975 Nov; 12(3): 189–98

    Article  PubMed  CAS  Google Scholar 

  24. Barbeau E, Didic M, Tramoni E, et al. Evaluation of visual recognition memory in MCI patients. Neurology 2004 Apr 27; 62(8): 1317–22

    Article  PubMed  CAS  Google Scholar 

  25. Deloche GeH D. Test de dénomination orale d’images DO80. Paris: INSERM, 1997

    Google Scholar 

  26. Reitan R. Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills 1958; 8: 271–6

    Google Scholar 

  27. Cardebat D, Doyon B, Puel M, et al. Formal and semantic lexical evocation in normal subjects: performance and dynamics of production as a function of sex, age and educational level. Acta Neurol Belg 1990; 90(4): 207–17

    PubMed  CAS  Google Scholar 

  28. Grober E, Buschke H, Crystal H, et al. Screening for dementia by memory testing. Neurology 1988 Jun; 38(6): 900–3

    Article  PubMed  CAS  Google Scholar 

  29. Sunderland T, Tariot PN, Cohen RM, et al. Anticholinergic sensitivity in patients with dementia of the Alzheimer type and age-matched controls: a dose-response study. Arch Gen Psychiatry 1987 May; 44(5): 418–26

    Article  PubMed  CAS  Google Scholar 

  30. Han L, Agostini JV, Allore HG. Cumulative anticholinergic exposure is associated with poor memory and executive function in older men. J Am Geriatr Soc 2008 Dec; 56(12): 2203–10

    Article  PubMed  Google Scholar 

  31. Carriere I, Fourrier-Reglat A, Dartigues JF, et al. Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study. Arch Intern Med 2009 Jul 27; 169(14): 1317–24

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to conduct this study or prepare this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this study. The authors would like to thank Dr Joan Glenn for revising the manuscript.

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Authors and Affiliations

  1. Centre hospitalier affilié universitaire de Québec, Hôpital de l’Enfant-Jésus, 1401 18ième rue, Québec, Canada, G1J 1Z4

    Marie-Pierre Fortin

  2. Hospices civils de Lyon, Lyon, France

    Isabelle Rouch, Virginie Dauphinot, Claire Gédéon, Stella Genthon, Marc Bonnefoy & Pierre Krolak-Salmon

  3. Hôpital des Charpennes, Hôpital universitaire de Lyon, Lyon, France

    Isabelle Rouch, Virginie Dauphinot & Pierre Krolak-Salmon

  4. Centre Mémoire, Ressource et Recherche, St-Étienne, France

    Isabelle Rouch

  5. Centre Mémoire, Ressource et Recherche, Lyon, France

    Virginie Dauphinot, Claire Gédéon, Stella Genthon, Marc Bonnefoy & Pierre Krolak-Salmon

  6. Université Claude Bernard Lyon, Lyon, France

    Marc Bonnefoy & Pierre Krolak-Salmon

  7. INSERM U 821, Centre Hospitalier Le Vinatier, Bron, France

    Pierre Krolak-Salmon

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  1. Marie-Pierre Fortin
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  2. Isabelle Rouch
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Correspondence to Marie-Pierre Fortin.

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Fortin, MP., Rouch, I., Dauphinot, V. et al. Effects of Anticholinergic Drugs on Verbal Episodic Memory Function in the Elderly. Drugs Aging 28, 195–204 (2011). https://doi.org/10.2165/11586580-000000000-00000

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