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

Published version
Peer-reviewed

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Authors

Grossi, Carlota M 
Richardson, Kathryn  ORCID logo  https://orcid.org/0000-0002-0741-8413
Fox, Chris 
Maidment, Ian 
Steel, Nicholas 

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.

Description

Keywords

Alzheimer disease, Benzodiazepines, Cholinergic antagonists, Cognition, Cohort study, Dementia, Aged, Aged, 80 and over, Benzodiazepines, Cholinergic Antagonists, Cognition, Cohort Studies, Dementia, Female, Follow-Up Studies, Humans, Incidence, Male, Mental Status and Dementia Tests, United Kingdom

Journal Title

BMC Geriatr

Conference Name

Journal ISSN

1471-2318
1471-2318

Volume Title

19

Publisher

Springer Science and Business Media LLC