Anticholinergic exposure and its association with dementia/Alzheimer's disease and mortality in older adults.

Autor: Poonawalla IB; Humana Healthcare Research, Humana Inc., 500 W Main St, Louisville, KY, 40202, USA. IPoonawalla@humana.com., Xu Y; Humana Healthcare Research, Humana Inc., 500 W Main St, Louisville, KY, 40202, USA., Gaddy R; Humana Pharmacy Solutions, Humana Inc., 500 W Main St, Louisville, KY, 40202, USA., James A; Humana Pharmacy Solutions, Humana Inc., 500 W Main St, Louisville, KY, 40202, USA., Ruble M; Humana Pharmacy Solutions, Humana Inc., 500 W Main St, Louisville, KY, 40202, USA., Burns S; Humana Pharmacy Solutions, Humana Inc., 500 W Main St, Louisville, KY, 40202, USA., Dixon SW; Humana Healthcare Research, Humana Inc., 500 W Main St, Louisville, KY, 40202, USA., Suehs BT; Humana Healthcare Research, Humana Inc., 500 W Main St, Louisville, KY, 40202, USA.
Jazyk: angličtina
Zdroj: BMC geriatrics [BMC Geriatr] 2023 Jun 30; Vol. 23 (1), pp. 401. Date of Electronic Publication: 2023 Jun 30.
DOI: 10.1186/s12877-023-04095-7
Abstrakt: Background: Use of anticholinergic (ACH) medications is associated with increased risk of cognitive decline in the elderly. However, little is known about this association from a health plan perspective.
Methods: This retrospective cohort study used the Humana Research Database to identify individuals with at least one ACH medication dispensed in 2015. Patients were followed until incidence of dementia/Alzheimer's disease, death, disenrollment or end of December 2019. Multivariate Cox regression models were used to assess the association between ACH exposure and study outcomes, adjusting for demographics and clinical characteristics.
Results: A total of 12,209 individuals with no prior ACH use or dementia/Alzheimer's disease diagnosis were included. As ACH polypharmacy increased (i.e., from no ACH exposure, to one, two, three, and four or more ACH medications), there was a stair-step increase in the incidence rate of dementia/Alzheimer's disease (15, 30, 46, 56 and 77 per 1,000 person-years of follow-up) and in the incidence of mortality (19, 37, 80, 115 and 159 per 1,000 person-years of follow-up). After adjusting for confounders, ACH exposure to one, two, three and four or more ACH medications was associated with a 1.6 (95% CI 1.4-1.9), 2.1 (95% CI 1.7-2.8), 2.6 (95% CI 1.5-4.4), and 2.6 (95% CI 1.1-6.3) times, respectively, increased risk of a dementia/Alzheimer's disease diagnosis compared to periods of no ACH exposure. ACH exposure to one, two, three and four or more medications was associated with a 1.4 (95% CI 1.2-1.6), 2.6 (95% CI 2.1-3.3), 3.8 (95% CI 2.6-5.4), and 3.4 (95% CI 1.8-6.4) times, respectively, increased risk of mortality compared to periods of no ACH exposure.
Conclusions: Reducing ACH exposure may potentially minimize long-term adverse effects in older adults. Results suggest populations which may benefit from targeted interventions to reduce ACH polypharmacy.
(© 2023. The Author(s).)
Databáze: MEDLINE
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