Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study
Identifieur interne : 000850 ( Main/Exploration ); précédent : 000849; suivant : 000851Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study
Auteurs : Uwe Ehrt [Norvège] ; Karl Broich [Allemagne] ; Jan Petter Larsen [Norvège] ; Clive Ballard [Royaume-Uni] ; Dag Aarsland [Norvège]Source :
- 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
Affiliations:
- Allemagne, Norvège, Royaume-Uni
- Angleterre, District de Cologne, Grand Londres, Rhénanie-du-Nord-Westphalie
- Bonn, Londres
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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><affiliations><list><country><li>Allemagne</li><li>Norvège</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>District de Cologne</li><li>Grand Londres</li><li>Rhénanie-du-Nord-Westphalie</li></region><settlement><li>Bonn</li><li>Londres</li></settlement></list><tree><country name="Norvège"><noRegion><name sortKey="Ehrt, Uwe" sort="Ehrt, Uwe" uniqKey="Ehrt U" first="Uwe" last="Ehrt">Uwe Ehrt</name></noRegion><name sortKey="Aarsland, Dag" sort="Aarsland, Dag" uniqKey="Aarsland D" first="Dag" last="Aarsland">Dag Aarsland</name><name sortKey="Aarsland, Dag" sort="Aarsland, Dag" uniqKey="Aarsland D" first="Dag" last="Aarsland">Dag Aarsland</name><name sortKey="Ehrt, Uwe" sort="Ehrt, Uwe" uniqKey="Ehrt U" first="Uwe" last="Ehrt">Uwe Ehrt</name><name sortKey="Larsen, Jan Petter" sort="Larsen, Jan Petter" uniqKey="Larsen J" first="Jan Petter" last="Larsen">Jan Petter Larsen</name><name sortKey="Larsen, Jan Petter" sort="Larsen, Jan Petter" uniqKey="Larsen J" first="Jan Petter" last="Larsen">Jan Petter Larsen</name></country><country name="Allemagne"><region name="Rhénanie-du-Nord-Westphalie"><name sortKey="Broich, Karl" sort="Broich, Karl" uniqKey="Broich K" first="Karl" last="Broich">Karl Broich</name></region></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Ballard, Clive" sort="Ballard, Clive" uniqKey="Ballard C" first="Clive" last="Ballard">Clive Ballard</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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