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Abstract
Objectives We aim to evaluate the association between anticholinergic drug (ACH) use and cognitive impairment and the effect of disparity parameters (sex, race, income, education, and rural or urban areas) on this relationship.
Methods The analyses included 13,623 adults aged ≥65 years from the REasons for Geographic And Racial Differences in Stroke study (recruited 2003–2007). The ACH use was defined by the 2015 Beers Criteria, and cognitive impairment was measured by the Six-Item Cognitive Screener. Multivariable logistic regression models assessed disparities in cognitive impairment with ACH use, iteratively adjusting for disparity parameters and other covariates. The full models included interaction terms between ACH use and other covariates. A similar approach was used for class-specific ACH exposure and cognitive impairment analyses.
Results Approximately 14% of the participants used at least 1 ACH listed in the Beers Criteria. Antidepressants were the most frequently prescribed ACH class. A significant sex-race interaction illustrated that females compared with males (in Blacks: odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.10–1.49 and in Whites: OR = 1.96, 95% CI 1.74–2.20), especially White females (Black vs White: OR = 0.71, 95% CI 0.64–0.80), were more likely to receive ACHs. Higher odds of cognitive impairment were observed among ACH users compared with the nonusers (OR = 1.26, 95% CI 1.01–1.58). In our class-level analyses, only antidepressant users (OR = 1.60, 95% CI 1.14–2.25) showed a significant association with cognitive impairment in the fully adjusted model.
Conclusions We observed demographic and socioeconomic differences in ACH use and in cognitive impairment, individually.
Footnotes
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.
- Received February 22, 2020.
- Accepted July 1, 2020.
- © 2021 American Academy of Neurology
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