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

## TL;DR

This study found that older adults with Alzheimer's disease who were taking anticholinergic medications at a memory clinic had worse cognitive and functional outcomes after one year, even after stopping the drugs.

## Contribution

The study provides evidence that prior anticholinergic use may negatively impact dementia prognosis in Alzheimer's patients despite drug discontinuation.

## Key findings

- MMSE scores at baseline and follow-up did not significantly differ between anticholinergic and non-anticholinergic groups overall.
- Subgroup analysis showed significant differences in initial MMSE and follow-up FAQ scores in Alzheimer's patients with anticholinergic use.
- Anticholinergic use in older adults with dementia may be associated with worse cognitive and functional outcomes despite drug discontinuation.

## Abstract

Anticholinergic medications carry increased risk of worsening cognition, particularly in patients with dementia.

Cognitive 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.

Longitudinal 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.

Between 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.

Findings 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.