Anticholinergic and benzodiazepine medication use and risk of incident dementia: a UK cohort study

Carlota M. Grossi, Kathryn Richardson* (Corresponding Author), Chris Fox, Ian Maidment, Nicholas Steel, Yoon K. Loke, Antony Arthur, Phyo Kyaw Myint, Noll Campbell, Malaz Boustani, Louise Robinson, Carol Brayne, Fiona E. Matthews, George M. Savva

*Corresponding author for this work

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Abstract

Background Studies suggest that anticholinergic medication or benzodiazepine use could increase dementia risk. We tested this hypothesis using data from a UK cohort study. Methods We used data from the baseline (Y0), 2-year (Y2) and 10-year (Y10) waves of the Medical Research Council Cognitive Function and Ageing Study. Participants without dementia at Y2 were included (n = 8216). Use of benzodiazepines (including nonbenzodiazepine Z-drugs), anticholinergics with score 3 (ACB3) and anticholinergics with score 1 or 2 (ACB12) according to the Anticholinergic Cognitive Burden scale were coded as ever use (use at Y0 or Y2), recurrent use (Y0 and Y2), new use (Y2, but not Y0) or discontinued use (Y0, but not Y2). The outcome was incident dementia by Y10. Incidence rate ratios (IRR) were estimated using Poisson regression adjusted for potential confounders. Pre-planned subgroup analyses were conducted by age, sex and Y2 Mini-Mental State Examination (MMSE) score. Results Dementia incidence was 9.3% (N = 220 cases) between Y2 and Y10. The adjusted IRRs (95%CI) of developing dementia were 1.06 (0.72, 1.60), 1.28 (0.82, 2.00) and 0.89 (0.68, 1.17) for benzodiazepines, ACB3 and ACB12 ever-users compared with non-users. For recurrent users the respective IRRs were 1.30 (0.79, 2.14), 1.68 (1.00, 2.82) and 0.95 (0.71, 1.28). ACB3 ever-use was associated with dementia among those with Y2 MMSE> 25 (IRR = 2.28 [1.32–3.92]), but not if Y2 MMSE≤25 (IRR = 0.94 [0.51–1.73]). Conclusions Neither benzodiazepines nor ACB12 medications were associated with dementia. Recurrent use of ACB3 anticholinergics was associated with dementia, particularly in those with good baseline cognitive function. The long-term prescribing of anticholinergics should be avoided in older people.
Original languageEnglish
Article number276
Number of pages10
JournalBMC Geriatrics
Volume19
DOIs
Publication statusPublished - 21 Oct 2019

Keywords

  • Alzheimer disease
  • Cognition
  • Dementia
  • Cohort study
  • Benzodiazepines
  • Cholinergic antagonists
  • DRUGS
  • DISEASE
  • OLDER
  • COGNITIVE IMPAIRMENT
  • PREVALENCE

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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    Grossi, C. M., Richardson, K., Fox, C., Maidment, I., Steel, N., Loke, Y. K., Arthur, A., Myint, P. K., Campbell, N., Boustani, M., Robinson, L., Brayne, C., Matthews, F. E., & Savva, G. M. (2019). Anticholinergic and benzodiazepine medication use and risk of incident dementia: a UK cohort study. BMC Geriatrics, 19, [276]. https://doi.org/10.1186/s12877-019-1280-2