Cognitive decline associated with anticholinergics, benzodiazepines, and Z‐drugs: findings from The Irish Longitudinal Study on Ageing (TILDA)

Moriarty, Frank, Savva, George, Grossi, Carlota M., Bennett, Kathleen, Fox, Chris ORCID:, Maidment, Ian, Loke, Yoon K., Steel, Nicholas ORCID:, Kenny, Rose Anne and Richardson, Kathryn ORCID: (2021) Cognitive decline associated with anticholinergics, benzodiazepines, and Z‐drugs: findings from The Irish Longitudinal Study on Ageing (TILDA). British Journal of Pharmacology, 87 (7). pp. 2818-2829. ISSN 0007-1188

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Aims: To estimate the association between patterns of anticholinergic, benzodiazepine and Z-drug medication use and change in cognitive function in middle-aged and older adults.  Methods: This prospective cohort study used data from the first three waves of The Irish Longitudinal Study on Ageing (TILDA), including community-dwelling adults aged ≥50 years followed for up to 4 years (n = 7027). Cognitive function was assessed using the Mini Mental State Examination, animal naming test and word recall tests. Regular medication use was self-reported at baseline and follow-up interviews at 2 and 4 years. Pharmacy dispensing claims for a subset (n = 2905) allowed assessment of medication use between interviews and cumulative dosage. Medication use at consecutive waves of TILDA was analysed in relation to change in cognitive function between waves.  Results: Strongly anticholinergic medications (Anticholinergic Cognitive Burden scale 3), benzodiazepines and Z-drugs were reported by 7.3%, 5.8% and 5.1% of participants, respectively, at any time during the study. Adjusting for potential confounders, new anticholinergic use between interviews was associated with change in recall score (−1.09, 95% confidence interval −1.64, −0.53) over 2 years compared to non-use, but not with MMSE (0.07; 95% CI −0.21, 0.34) or animal naming (−0.70; 95% CI −1.43, 0.03). The pharmacy claims analysis was consistent with this finding. Other hypothesised associations were not supported.  Conclusions: Except for new use of anticholinergic medications, no other findings supported a risk of cognitive decline over 2-year periods in this middle-aged and older cohort. Patients and prescribers should weigh this potential risk against potential benefits of commencing anticholinergic medications.

Item Type: Article
Additional Information: Funding Information: This work was supported by the UK Alzheimer's Society [AS‐PG‐2013‐017]. Funding for TILDA is provided by the Irish Government, the Atlantic Philanthropies and Irish Life.
Uncontrolled Keywords: z-drugs,anticholinergic medication,benzodiazepines,cognitive function,pharmacoepidemiology,pharmacology,pharmacology (medical) ,/dk/atira/pure/subjectarea/asjc/3000/3004
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 09 Dec 2020 01:07
Last Modified: 22 Oct 2022 07:33
DOI: 10.1111/bcp.14687

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