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Anticholinergic drugs increase the risk of cognitive decline and dementia in older people

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What is the relationship between anticholinergic use, cognitive decline and onset of dementia in an older, community-dwelling population?


6912 adults (4128 women, mean age 73.8 years; 2784 men, mean age 73.6 years) aged ≥65 years, living in the community and recruited from electoral rolls.


Three cities in France, recruitment period: 1999–2001.

Prognostic factors:

Cognitive performance was measured using a battery of tests: Isaacs Set Test assessed verbal fluency, Benton Visual Retention Test (BVRT) assessed visual memory, Trail-Making Test A (TMT A) measured psychomotor speed, TMT B measured executive function, Mini-Mental State Examination (MMSE) provided a global measure of cognitive function and clinical diagnoses of dementia (Diagnostic and Statistical Manual of Mental Disorders, fourth edition). The use of anticholinergic drugs was assessed by in-person interview; prescriptions and medications were checked where possible. Discontinuing anticholinergic treatment was defined as reporting anticholinergic drug use only at baseline but not at either the 2- or 4-year follow-up. Social and demographic variables were recorded using standardised interview questions. Fasting-blood samples were taken to determine cholesterol levels. Cognitive tests were administered at baseline and at 2- and 4-year follow-up. TMT A and B were administered only at the 4-year follow-up. Univariate and multivariate logistic regression analyses were performed to determine the association between anticholinergic drug use and cognitive decline.


Cognitive decline (defined as being in the lowest quintile of the difference between …

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  • Sources of funding Inserm, Victor Segalen-Bordeaux II University and Sanofi-Aventis, Caisse Nationale Maladie des Travailleurs Salaries, Direction Générale de al Santé, Mutuelle Générale de l’Education Nationale, lnstitut de la Longévité, Agence Francaise de Sécurité Sanitaire des Produits de Santé, the Regional Governments of Aquitaine, Bourgogne and Languedoc-Rousillion, Fondation de France and the Ministry of Research-Inserm Programme « Cohorts and collection of biological material ». Lille Génopôle recieved an unconditional grant from Eisai. Fondation pour la Recherche Médicale funded the preparation and fi rst phase of the study.


  • Competing interests None

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