Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study
Identifieur interne : 003121 ( Main/Corpus ); précédent : 003120; suivant : 003122Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study
Auteurs : Uwe Ehrt ; Karl Broich ; Jan Petter Larsen ; Clive Ballard ; Dag AarslandSource :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2010-02.
Abstract
Background Cognitive decline is common in Parkinson's disease (PD). Although some of the aetiological factors are known, it is not yet known whether drugs with anticholinergic activity (AA) contribute to this cognitive decline. Such knowledge would provide opportunities to prevent acceleration of cognitive decline in PD. Objective To study whether the use of agents with anticholinergic properties is an independent risk factor for cognitive decline in patients with PD. Methods A community-based cohort of patients with PD (n=235) were included and assessed at baseline. They were reassessed 4 and 8 years later. Cognition was assessed using the Mini-Mental State Examination (MMSE). A detailed assessment of the AA of all drugs prescribed was made, and AA was classified according to a standardised scale. Relationships between cognitive decline and AA load and duration of treatment were assessed using bivariate and multivariate statistical analyses. Results More than 40% used drugs with AA at baseline. During the 8-year follow-up, the cognitive decline was higher in those who had been taking AA drugs (median decline on MMSE 6.5 points) compared with those who had not taken such drugs (median decline 1 point; p=0.025). In linear regression analyses adjusting for age, baseline cognition and depression, significant associations with decline on MMSE were found for total AA load (standardised β=0.229, p=0.04) as well as the duration of using AA drugs (standardised β 0.231, p=0.032). Conclusion Our findings suggest that there is an association between anticholinergic drug use and cognitive decline in PD. This may provide an important opportunity for clinicians to avoid increasing progression of cognitive decline by avoiding drugs with AA. Increased awareness by clinicians is required about the classes of drugs that have anticholinergic properties.
Url:
DOI: 10.1136/jnnp.2009.186239
Links to Exploration step
ISTEX:AFF852A5F5B8A037EB1C457F32D30158D3053409Le document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study</title><author><name sortKey="Ehrt, Uwe" sort="Ehrt, Uwe" uniqKey="Ehrt U" first="Uwe" last="Ehrt">Uwe Ehrt</name><affiliation><mods:affiliation>Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: uehr@sus.no</mods:affiliation></affiliation></author><author><name sortKey="Broich, Karl" sort="Broich, Karl" uniqKey="Broich K" first="Karl" last="Broich">Karl Broich</name><affiliation><mods:affiliation>Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany</mods:affiliation></affiliation></author><author><name sortKey="Larsen, Jan Petter" sort="Larsen, Jan Petter" uniqKey="Larsen J" first="Jan Petter" last="Larsen">Jan Petter Larsen</name><affiliation><mods:affiliation>The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology, Stavanger University Hospital, Stavanger, Norway</mods:affiliation></affiliation></author><author><name sortKey="Ballard, Clive" sort="Ballard, Clive" uniqKey="Ballard C" first="Clive" last="Ballard">Clive Ballard</name><affiliation><mods:affiliation>Wolfson Center for Age-Related Diseases, Kings College, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Aarsland, Dag" sort="Aarsland, Dag" uniqKey="Aarsland D" first="Dag" last="Aarsland">Dag Aarsland</name><affiliation><mods:affiliation>Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway</mods:affiliation></affiliation><affiliation><mods:affiliation>Institute of Clinical Medicine, University of Bergen, Bergen, Norway</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:AFF852A5F5B8A037EB1C457F32D30158D3053409</idno><date when="2009" year="2009">2009</date><idno type="doi">10.1136/jnnp.2009.186239</idno><idno type="url">https://api.istex.fr/document/AFF852A5F5B8A037EB1C457F32D30158D3053409/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">003121</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study</title><author><name sortKey="Ehrt, Uwe" sort="Ehrt, Uwe" uniqKey="Ehrt U" first="Uwe" last="Ehrt">Uwe Ehrt</name><affiliation><mods:affiliation>Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: uehr@sus.no</mods:affiliation></affiliation></author><author><name sortKey="Broich, Karl" sort="Broich, Karl" uniqKey="Broich K" first="Karl" last="Broich">Karl Broich</name><affiliation><mods:affiliation>Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany</mods:affiliation></affiliation></author><author><name sortKey="Larsen, Jan Petter" sort="Larsen, Jan Petter" uniqKey="Larsen J" first="Jan Petter" last="Larsen">Jan Petter Larsen</name><affiliation><mods:affiliation>The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology, Stavanger University Hospital, Stavanger, Norway</mods:affiliation></affiliation></author><author><name sortKey="Ballard, Clive" sort="Ballard, Clive" uniqKey="Ballard C" first="Clive" last="Ballard">Clive Ballard</name><affiliation><mods:affiliation>Wolfson Center for Age-Related Diseases, Kings College, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Aarsland, Dag" sort="Aarsland, Dag" uniqKey="Aarsland D" first="Dag" last="Aarsland">Dag Aarsland</name><affiliation><mods:affiliation>Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway</mods:affiliation></affiliation><affiliation><mods:affiliation>Institute of Clinical Medicine, University of Bergen, Bergen, Norway</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2010-02">2010-02</date><biblScope unit="volume">81</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="160">160</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">AFF852A5F5B8A037EB1C457F32D30158D3053409</idno><idno type="DOI">10.1136/jnnp.2009.186239</idno><idno type="href">jnnp-81-160.pdf</idno><idno type="ArticleID">jnnp186239</idno><idno type="PMID">19770163</idno><idno type="Related-article-Href">10.1136/jnnp.2009.194548</idno><idno type="Related-article-Href">10.1136/jnnp.2009.194548</idno><idno type="related-article-ID">RA1</idno><idno type="local">jnnp;81/2/160</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background Cognitive decline is common in Parkinson's disease (PD). Although some of the aetiological factors are known, it is not yet known whether drugs with anticholinergic activity (AA) contribute to this cognitive decline. Such knowledge would provide opportunities to prevent acceleration of cognitive decline in PD. Objective To study whether the use of agents with anticholinergic properties is an independent risk factor for cognitive decline in patients with PD. Methods A community-based cohort of patients with PD (n=235) were included and assessed at baseline. They were reassessed 4 and 8 years later. Cognition was assessed using the Mini-Mental State Examination (MMSE). A detailed assessment of the AA of all drugs prescribed was made, and AA was classified according to a standardised scale. Relationships between cognitive decline and AA load and duration of treatment were assessed using bivariate and multivariate statistical analyses. Results More than 40% used drugs with AA at baseline. During the 8-year follow-up, the cognitive decline was higher in those who had been taking AA drugs (median decline on MMSE 6.5 points) compared with those who had not taken such drugs (median decline 1 point; p=0.025). In linear regression analyses adjusting for age, baseline cognition and depression, significant associations with decline on MMSE were found for total AA load (standardised β=0.229, p=0.04) as well as the duration of using AA drugs (standardised β 0.231, p=0.032). Conclusion Our findings suggest that there is an association between anticholinergic drug use and cognitive decline in PD. This may provide an important opportunity for clinicians to avoid increasing progression of cognitive decline by avoiding drugs with AA. Increased awareness by clinicians is required about the classes of drugs that have anticholinergic properties.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Uwe Ehrt</name><affiliations><json:string>Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway</json:string><json:string>E-mail: uehr@sus.no</json:string></affiliations></json:item><json:item><name>Karl Broich</name><affiliations><json:string>Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany</json:string></affiliations></json:item><json:item><name>Jan Petter Larsen</name><affiliations><json:string>The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway</json:string><json:string>Department of Neurology, Stavanger University Hospital, Stavanger, Norway</json:string></affiliations></json:item><json:item><name>Clive Ballard</name><affiliations><json:string>Wolfson Center for Age-Related Diseases, Kings College, London, UK</json:string></affiliations></json:item><json:item><name>Dag Aarsland</name><affiliations><json:string>Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway</json:string><json:string>Institute of Clinical Medicine, University of Bergen, Bergen, Norway</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Research paper</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Dementia</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>cognitive decline</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>anticholinergic burden</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Background Cognitive decline is common in Parkinson's disease (PD). Although some of the aetiological factors are known, it is not yet known whether drugs with anticholinergic activity (AA) contribute to this cognitive decline. Such knowledge would provide opportunities to prevent acceleration of cognitive decline in PD. Objective To study whether the use of agents with anticholinergic properties is an independent risk factor for cognitive decline in patients with PD. Methods A community-based cohort of patients with PD (n=235) were included and assessed at baseline. They were reassessed 4 and 8 years later. Cognition was assessed using the Mini-Mental State Examination (MMSE). A detailed assessment of the AA of all drugs prescribed was made, and AA was classified according to a standardised scale. Relationships between cognitive decline and AA load and duration of treatment were assessed using bivariate and multivariate statistical analyses. Results More than 40% used drugs with AA at baseline. During the 8-year follow-up, the cognitive decline was higher in those who had been taking AA drugs (median decline on MMSE 6.5 points) compared with those who had not taken such drugs (median decline 1 point; p=0.025). In linear regression analyses adjusting for age, baseline cognition and depression, significant associations with decline on MMSE were found for total AA load (standardised β=0.229, p=0.04) as well as the duration of using AA drugs (standardised β 0.231, p=0.032). Conclusion Our findings suggest that there is an association between anticholinergic drug use and cognitive decline in PD. This may provide an important opportunity for clinicians to avoid increasing progression of cognitive decline by avoiding drugs with AA. Increased awareness by clinicians is required about the classes of drugs that have anticholinergic properties.</abstract><qualityIndicators><score>7.459</score><pdfVersion>1.4</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>1866</abstractCharCount><pdfWordCount>3959</pdfWordCount><pdfCharCount>28291</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>279</abstractWordCount></qualityIndicators><title>Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study</title><pmid><json:string>19770163</json:string></pmid><genre><json:string>research-article</json:string></genre><host><volume>81</volume><pages><first>160</first></pages><issn><json:string>0022-3050</json:string></issn><issue>2</issue><genre></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-330X</json:string></eissn><title>Journal of Neurology, Neurosurgery & Psychiatry</title></host><publicationDate>2010</publicationDate><copyrightDate>2009</copyrightDate><doi><json:string>10.1136/jnnp.2009.186239</json:string></doi><id>AFF852A5F5B8A037EB1C457F32D30158D3053409</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/AFF852A5F5B8A037EB1C457F32D30158D3053409/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/AFF852A5F5B8A037EB1C457F32D30158D3053409/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/AFF852A5F5B8A037EB1C457F32D30158D3053409/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd</publisher><availability><p>BMJ</p></availability><date>2009-09-21</date></publicationStmt><notesStmt><note>See Editorial Commentary, p129</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study</title><author corresp="yes"><persName><forename type="first">Uwe</forename><surname>Ehrt</surname></persName><email>uehr@sus.no</email><affiliation>Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway</affiliation></author><author><persName><forename type="first">Karl</forename><surname>Broich</surname></persName><affiliation>Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany</affiliation></author><author><persName><forename type="first">Jan Petter</forename><surname>Larsen</surname></persName><affiliation>The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway</affiliation><affiliation>Department of Neurology, Stavanger University Hospital, Stavanger, Norway</affiliation></author><author><persName><forename type="first">Clive</forename><surname>Ballard</surname></persName><affiliation>Wolfson Center for Age-Related Diseases, Kings College, London, UK</affiliation></author><author><persName><forename type="first">Dag</forename><surname>Aarsland</surname></persName><affiliation>Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway</affiliation><affiliation>Institute of Clinical Medicine, University of Bergen, Bergen, Norway</affiliation></author></analytic><monogr><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="pISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2010-02"></date><biblScope unit="volume">81</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="160">160</biblScope></imprint></monogr><idno type="istex">AFF852A5F5B8A037EB1C457F32D30158D3053409</idno><idno type="DOI">10.1136/jnnp.2009.186239</idno><idno type="href">jnnp-81-160.pdf</idno><idno type="ArticleID">jnnp186239</idno><idno type="PMID">19770163</idno><idno type="Related-article-Href">10.1136/jnnp.2009.194548</idno><idno type="Related-article-Href">10.1136/jnnp.2009.194548</idno><idno type="related-article-ID">RA1</idno><idno type="local">jnnp;81/2/160</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2009-09-21</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Background Cognitive decline is common in Parkinson's disease (PD). Although some of the aetiological factors are known, it is not yet known whether drugs with anticholinergic activity (AA) contribute to this cognitive decline. Such knowledge would provide opportunities to prevent acceleration of cognitive decline in PD. Objective To study whether the use of agents with anticholinergic properties is an independent risk factor for cognitive decline in patients with PD. Methods A community-based cohort of patients with PD (n=235) were included and assessed at baseline. They were reassessed 4 and 8 years later. Cognition was assessed using the Mini-Mental State Examination (MMSE). A detailed assessment of the AA of all drugs prescribed was made, and AA was classified according to a standardised scale. Relationships between cognitive decline and AA load and duration of treatment were assessed using bivariate and multivariate statistical analyses. Results More than 40% used drugs with AA at baseline. During the 8-year follow-up, the cognitive decline was higher in those who had been taking AA drugs (median decline on MMSE 6.5 points) compared with those who had not taken such drugs (median decline 1 point; p=0.025). In linear regression analyses adjusting for age, baseline cognition and depression, significant associations with decline on MMSE were found for total AA load (standardised β=0.229, p=0.04) as well as the duration of using AA drugs (standardised β 0.231, p=0.032). Conclusion Our findings suggest that there is an association between anticholinergic drug use and cognitive decline in PD. This may provide an important opportunity for clinicians to avoid increasing progression of cognitive decline by avoiding drugs with AA. Increased awareness by clinicians is required about the classes of drugs that have anticholinergic properties.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Dementia</term></item><item><term>Parkinson's disease</term></item><item><term>cognitive decline</term></item><item><term>anticholinergic burden</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2009-09-21">Created</change><change when="2010-02">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/AFF852A5F5B8A037EB1C457F32D30158D3053409/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jnnp</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id><journal-id journal-id-type="publisher-id">JNNP</journal-id><journal-title>Journal of Neurology, Neurosurgery & Psychiatry</journal-title><abbrev-journal-title abbrev-type="publisher">J Neurol Neurosurg Psychiatry</abbrev-journal-title><abbrev-journal-title>J Neurol Neurosurg Psychiatry</abbrev-journal-title><issn pub-type="ppub">0022-3050</issn><issn pub-type="epub">1468-330X</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">jnnp186239</article-id><article-id pub-id-type="doi">10.1136/jnnp.2009.186239</article-id><article-id pub-id-type="other">jnnp;81/2/160</article-id><article-id pub-id-type="other">jnnp;jnnp.2009.186239</article-id><article-id pub-id-type="pmid">19770163</article-id><article-id pub-id-type="other">160</article-id><article-id pub-id-type="other">jnnp.2009.186239</article-id><article-categories><subj-group subj-group-type="heading"><subject content-type="original">Research paper</subject></subj-group></article-categories><title-group><article-title>Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Ehrt</surname><given-names>Uwe</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Broich</surname><given-names>Karl</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Larsen</surname><given-names>Jan Petter</given-names></name><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Ballard</surname><given-names>Clive</given-names></name><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Aarsland</surname><given-names>Dag</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff6">6</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway</aff><aff id="aff2"><label>2</label>The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway</aff><aff id="aff3"><label>3</label>Department of Neurology, Stavanger University Hospital, Stavanger, Norway</aff><aff id="aff4"><label>4</label>Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany</aff><aff id="aff5"><label>5</label>Wolfson Center for Age-Related Diseases, Kings College, London, UK</aff><aff id="aff6"><label>6</label>Institute of Clinical Medicine, University of Bergen, Bergen, Norway</aff><author-notes><corresp><label>Correspondence to</label> Dr Uwe Ehrt, Stavanger University Hospital, Psychiatric Clinic, PO Box 1163, Hillevåg, 4095 Stavanger, Norway; <email>uehr@sus.no</email></corresp><fn fn-type="other"><p>See Editorial Commentary, <related-article id="RA1" related-article-type="in-this-issue" ext-link-type="doi" xlink:type="simple" xlink:href="10.1136/jnnp.2009.194548">p129</related-article></p></fn><fn fn-type="other"><label>Linked articles</label><p><related-article id="RA2" related-article-type="in-this-issue" ext-link-type="doi" xlink:type="simple" xlink:href="10.1136/jnnp.2009.194548">194548</related-article></p></fn><fn fn-type="other"><p>CB has received honoraria from Novartis, Pfizer, Shire, Lundbeck, Myriad, Janssen, Astra Zeneca and Servier pharmaceutical companies, and research grants from Novartis, Lundbeck, Astra-Zeneca and Janssen pharmaceuticals. DA has received honoraria from Novartis, Lundbeck, GE Health and Merck Serono and received 9.5 mill NOK, 2003–2007 (Age Research programme 153480); Health Region Western Norway; 500 000 NOK/year, 2008–2010 for the project Neurochemistry for dementia and PD; unrestricted industry grants 100 000 NOK/year from Kavli fund. DA received honoraria from Novartis, Lundbeck, GE Health and Merck Serono.</p></fn></author-notes><pub-date pub-type="epub-original"><day>21</day><month>9</month><year>2009</year></pub-date><pub-date pub-type="ppub"><month>2</month><year>2010</year></pub-date><pub-date pub-type="epub"><day>21</day><month>9</month><year>2009</year></pub-date><volume>81</volume><volume-id pub-id-type="other">81</volume-id><volume-id pub-id-type="other">81</volume-id><issue>2</issue><issue-id pub-id-type="other">jnnp;81/2</issue-id><issue-id pub-id-type="other">2</issue-id><issue-id pub-id-type="other">81/2</issue-id><fpage>160</fpage><history><date date-type="received"><day>1</day><month>7</month><year>2009</year></date><date date-type="rev-recd"><day>17</day><month>8</month><year>2009</year></date><date date-type="accepted"><day>21</day><month>8</month><year>2009</year></date></history><permissions><copyright-statement>© 2009, Published by the BMJ Publishing Group Limited For permission to use, (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</copyright-statement><copyright-year>2009</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jnnp-81-160.pdf"></self-uri><abstract><sec><title>Background</title><p>Cognitive decline is common in Parkinson's disease (PD). Although some of the aetiological factors are known, it is not yet known whether drugs with anticholinergic activity (AA) contribute to this cognitive decline. Such knowledge would provide opportunities to prevent acceleration of cognitive decline in PD.</p></sec><sec><title>Objective</title><p>To study whether the use of agents with anticholinergic properties is an independent risk factor for cognitive decline in patients with PD.</p></sec><sec><title>Methods</title><p>A community-based cohort of patients with PD (n=235) were included and assessed at baseline. They were reassessed 4 and 8 years later. Cognition was assessed using the Mini-Mental State Examination (MMSE). A detailed assessment of the AA of all drugs prescribed was made, and AA was classified according to a standardised scale. Relationships between cognitive decline and AA load and duration of treatment were assessed using bivariate and multivariate statistical analyses.</p></sec><sec><title>Results</title><p>More than 40% used drugs with AA at baseline. During the 8-year follow-up, the cognitive decline was higher in those who had been taking AA drugs (median decline on MMSE 6.5 points) compared with those who had not taken such drugs (median decline 1 point; p=0.025). In linear regression analyses adjusting for age, baseline cognition and depression, significant associations with decline on MMSE were found for total AA load (standardised β=0.229, p=0.04) as well as the duration of using AA drugs (standardised β 0.231, p=0.032).</p></sec><sec><title>Conclusion</title><p>Our findings suggest that there is an association between anticholinergic drug use and cognitive decline in PD. This may provide an important opportunity for clinicians to avoid increasing progression of cognitive decline by avoiding drugs with AA. Increased awareness by clinicians is required about the classes of drugs that have anticholinergic properties.</p></sec></abstract><kwd-group><kwd>Dementia</kwd><kwd>Parkinson's disease</kwd><kwd>cognitive decline</kwd><kwd>anticholinergic burden</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Uwe</namePart><namePart type="family">Ehrt</namePart><affiliation>Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway</affiliation><affiliation>E-mail: uehr@sus.no</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Karl</namePart><namePart type="family">Broich</namePart><affiliation>Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jan Petter</namePart><namePart type="family">Larsen</namePart><affiliation>The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway</affiliation><affiliation>Department of Neurology, Stavanger University Hospital, Stavanger, Norway</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Clive</namePart><namePart type="family">Ballard</namePart><affiliation>Wolfson Center for Age-Related Diseases, Kings College, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Dag</namePart><namePart type="family">Aarsland</namePart><affiliation>Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway</affiliation><affiliation>Institute of Clinical Medicine, University of Bergen, Bergen, Norway</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2010-02</dateIssued><dateCreated encoding="w3cdtf">2009-09-21</dateCreated><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Background Cognitive decline is common in Parkinson's disease (PD). Although some of the aetiological factors are known, it is not yet known whether drugs with anticholinergic activity (AA) contribute to this cognitive decline. Such knowledge would provide opportunities to prevent acceleration of cognitive decline in PD. Objective To study whether the use of agents with anticholinergic properties is an independent risk factor for cognitive decline in patients with PD. Methods A community-based cohort of patients with PD (n=235) were included and assessed at baseline. They were reassessed 4 and 8 years later. Cognition was assessed using the Mini-Mental State Examination (MMSE). A detailed assessment of the AA of all drugs prescribed was made, and AA was classified according to a standardised scale. Relationships between cognitive decline and AA load and duration of treatment were assessed using bivariate and multivariate statistical analyses. Results More than 40% used drugs with AA at baseline. During the 8-year follow-up, the cognitive decline was higher in those who had been taking AA drugs (median decline on MMSE 6.5 points) compared with those who had not taken such drugs (median decline 1 point; p=0.025). In linear regression analyses adjusting for age, baseline cognition and depression, significant associations with decline on MMSE were found for total AA load (standardised β=0.229, p=0.04) as well as the duration of using AA drugs (standardised β 0.231, p=0.032). Conclusion Our findings suggest that there is an association between anticholinergic drug use and cognitive decline in PD. This may provide an important opportunity for clinicians to avoid increasing progression of cognitive decline by avoiding drugs with AA. Increased awareness by clinicians is required about the classes of drugs that have anticholinergic properties.</abstract><note type="footnotes">See Editorial Commentary, p129</note><subject><genre>Keywords</genre><topic>Dementia</topic><topic>Parkinson's disease</topic><topic>cognitive decline</topic><topic>anticholinergic burden</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Neurology, Neurosurgery & Psychiatry</title></titleInfo><titleInfo type="abbreviated"><title>J Neurol Neurosurg Psychiatry</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0022-3050</identifier><identifier type="eISSN">1468-330X</identifier><identifier type="PublisherID">JNNP</identifier><identifier type="PublisherID-hwp">jnnp</identifier><identifier type="PublisherID-nlm-ta">J Neurol Neurosurg Psychiatry</identifier><part><date>2010</date><detail type="volume"><caption>vol.</caption><number>81</number></detail><detail type="issue"><caption>no.</caption><number>2</number></detail><extent unit="pages"><start>160</start></extent></part></relatedItem><identifier type="istex">AFF852A5F5B8A037EB1C457F32D30158D3053409</identifier><identifier type="DOI">10.1136/jnnp.2009.186239</identifier><identifier type="href">jnnp-81-160.pdf</identifier><identifier type="ArticleID">jnnp186239</identifier><identifier type="PMID">19770163</identifier><identifier type="Related-article-Href">10.1136/jnnp.2009.194548</identifier><identifier type="Related-article-Href">10.1136/jnnp.2009.194548</identifier><identifier type="related-article-ID">RA1</identifier><identifier type="local">jnnp;81/2/160</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2009, Published by the BMJ Publishing Group Limited For permission to use, (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</accessCondition><recordInfo><recordContentSource>BMJ</recordContentSource></recordInfo></mods></metadata><annexes><json:item><original>true</original><mimetype>image/jpeg</mimetype><extension>jpeg</extension><uri>https://api.istex.fr/document/AFF852A5F5B8A037EB1C457F32D30158D3053409/annexes/jpeg</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/ParkinsonV1/Data/Main/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 003121 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Main/Corpus/biblio.hfd -nk 003121 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= ParkinsonV1
|flux= Main
|étape= Corpus
|type= RBID
|clé= ISTEX:AFF852A5F5B8A037EB1C457F32D30158D3053409
|texte= Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study
}}
| This area was generated with Dilib version V0.6.23. |  |