This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
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
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
The Nerve!: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Topics Discussed
Alert Me
Recommended articles
Sex and Race Differences in the Risk of Ischemic Stroke Associated With Fasting Blood Glucose in REGARDS
Inflammatory cytokines and ischemic stroke risk
Report of stroke-like symptoms predicts incident cognitive impairment in a stroke-free cohort
Use of anticholinergics and the risk of cognitive impairment in an African American population