Does anticholinergic medication use on presentation to a rural memory clinic predict cognitive or functional decline over one year?

BackgroundAnticholinergic medications carry increased risk of worsening cognition, particularly in patients with dementia.ObjectiveCognitive and functional scores of patients were compared at 1-year follow up after cessation of prior anticholinergic medications to those who were not taking anticholinergics at baseline to assess whether prior anticholinergic use affected dementia prognosis in memory clinic patients.MethodsLongitudinal data from 578 consecutive patients with diagnoses including Alzheimer's disease (AD), frontotemporal and vascular dementia, Lewy body dementia, mild cognitive impairment and dementia due to non-AD etiologies compared patients taking anticholinergic drugs to those taking none at intake. Anticholinergic drugs were discontinued in all patients at initial visit. Mini-Mental Status Examination (MMSE) and Functional Activities Questionnaire (FAQ) were administered at intake and 1-year follow up.ResultsBetween the no-anticholinergic and anticholinergic groups, MMSE at baseline did not significantly differ when the entire sample was compared. In addition, MMSE score change between baseline and follow-up did not significantly differ. Similarly, no significant differences were observed between groups in FAQ at baseline or in FAQ change between timepoints. Subgroup analysis of only those with AD yielded statistically significant differences in initial MMSE. However, these groups had statistically similar follow-up MMSE. Although initial FAQ scores were similar, there were significant differences in follow-up FAQ in patients with AD.ConclusionsFindings suggest that patients with AD presenting on anticholinergic medications may do worse cognitively and functionally than those who were never on anticholinergics despite baseline discontinuation. Anticholinergic medication use in older adults should be approached cautiously.