Long‐term anticholinergic, benzodiazepine and Z‐drug use in community‐dwelling older adults: What is the impact on cognitive and neuropsychological performance?. (10th July 2021)

• Record Type: Journal Article
• Authors: Dyer, Adam H.; Laird, Eamon; Hoey, Leane; Hughes, Catherine F.; McNulty, Helene; Ward, Mary; Strain, J. J.; Molloy, Anne M.; Cunningham, Conal; McCarroll, Kevin
• Is Part Of: International journal of geriatric psychiatry. Volume 36:Number 11(2021)
• Page Start: 1767
• Page End: 1777
• Publication Date: 2021-07-10
• Subjects: anticholinergic medication -- benzodiazepine -- cognition -- older adults; Geriatric psychiatry -- Periodicals; Geriatric Psychiatry -- Periodicals; 618.97689
• DOI: 10.1002/gps.5598
• Languages: English
• ISSNs: 0885-6230

Abstract

Abstract: Background: Long‐term use of anticholinergics, benzodiazepines and related drugs (or "Z‐drugs") have been associated with cognitive impairment and dementia. However, the relationship of these medications with cognitive function and domain‐specific neuropsychological performance in older adults without dementia, is unclear. Methods: 5135 older adults (74.0 ± 8.3 years; 67.4% female) without a diagnosis of dementia were recruited in Ireland to the Trinity‐Ulster‐Department of Agriculture (TUDA) study. Detailed cognitive and neuropsychological assessment was conducted using the Mini‐Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Results: A total of 44% (2259 of 5153) used either a potential or definite anticholinergic medication. Overall, 9.7% ( n = 500) used a definite anticholinergic medication. Regular benzodiazepine use was reported by 7% ( n = 363), whilst 7.5% ( n = 387) used a "Z‐drug". Use of definite, but not potential anticholinergic medication was associated with poorer performance on all three assessments (β: −0.09; 95% CI: −0.14, −0.03, p = 0.002 for MMSE; β: −0.04; 95% CI: −0.06, −0.02; p < 0.001 for FAB; β: −4.15; 95% CI: −5.64, −2.66; p < 0.001 for RBANS) in addition to all domains of the RBANS. Regular benzodiazepine use was also associated with poorer neuropsychological test performance, especially in Immediate Memory (β: −4.98; 95% CI: −6.81, −3.15; p < 0.001) and Attention (β: −6.81; 95% CI: −8.60, −5.03; p < 0.001) RBANS domains. Conclusions: Regular use of definite anticholinergic medications and benzodiazepines, but not potential anticholinergics or "Z‐drugs", was associated with poorer overall and domain‐specific neuropsychological performance in older adults. Key points: Use of both anticholinergic medication and benzodiazepines have been associated with dementia in older adults. Use of these medications and domain‐specific cognitive performance in those without dementia, is less well‐understood. In >5000 older adults, use of these medications was associated with poorer overall and domain‐specific cognitive performance. These findings have important implications for risk vs benefit decisions of prescribing these medications in older adults.