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Moriarty, Frank, Savva, George, Grossi, Carlota M., Bennett, Kathleen, Fox, Chris 
ORCID: https://orcid.org/0000-0001-9480-5704, Maidment, Ian, Loke, Yoon K., Steel, Nicholas ORCID: https://orcid.org/0000-0003-1528-140X, Kenny, Rose Anne and Richardson, Kathryn ORCID: https://orcid.org/0000-0002-0741-8413
(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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Abstract
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.
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