Effect of anticholinergic burden on the development of dementia in older adults with subjective cognitive decline

Figures & data

Figure 1. Sample selection of the study. Note: SCD, subjective cognitive decline and ACB, anticholinergic cognitive burden.

Table 1. Initial characteristics of all subjects included in the longitudinal study.

	Subjective cognitive decline
Variables	Total (N = 109)	Group I (N = 94)	Group II (N = 15)	p
Age at SCD^a incidence	N = 109	N = 94	N = 15	<.0001^b
65–74	69 (63.3)	64 (68.1)	5 (33.3)
75–84	36 (33.0)	29 (30.8)	7 (46.7)
85+	4 (3.7)	1 (1.1)	3 (20.0)
Gender	N = 109	N = 94	N = 15	.263
No. (%) female	72 (66.1)	64 (68.1)	8 (53.3)
Months of follow up	N = 109	N = 94	N = 15	.072^c
median (min–max)	75 (36–185)	76 (36–185)	65 (36–139)
Living status	N = 109	N = 94	N = 15	.521
Spouse	72 (66.1)	61 (64.9)	11 (73.3)
Other^d	37 (33.9)	33 (35.1)	4 (26.7)
Education^e	N = 107	N = 92	N = 15	.960^c
median (years)	8 (0–18)	8 (0–18)	8 (0–15)
Smoking status^e	N = 108	N = 94	N = 14	.274
Never	100 (92.6)	88 (93.6)	12 (85.7)
Former	2 (1.8)	2 (2.1)	0 (0.0)
Current	6 (5.6)	4 (4.3)	2 (14.3)
Alcohol status^e	N = 108	N = 94	N = 14	.271
Never	105 (97.2)	92 (97.8)	13 (92.9)
Former	1 (0.9)	1 (1.1)	0 (0.0)
Current	2 (1.9)	1 (1.1)	1 (7.1)
Physical activity^e	N = 108	N = 94	N = 14	.429
None	52 (48.2)	43 (45.7)	9 (64.3)
Moderate	24 (22.2)	22 (23.4)	2 (14.3)
Heavy	32 (29.6)	29 (30.9)	3 (21.4)
Hypertension	N = 109	N = 94	N = 15	.027
No. (%) Yes	75 (68.8)	61 (64.9)	14 (93.3)
Diabetes mellitus	N = 109	N = 94	N = 15	.114
No. (%) Yes	26 (23.9)	20 (21.3)	6 (40.0)
Depression^e	N = 105	N = 92	N = 13	.504
No. (%) Yes	32 (30.5)	27 (29.4)	5 (38.5)
MMSE^c^,^e (0–30)	N = 107	N = 93	N = 14	.013^c
median (min–max)	29 (23–30)	29 (23–30)	28 (24–30)
YGDS^c^,^e(0–15)	N = 105	N = 92	N = 13	.413^c
median (min–max)	3 (0–12)	2 (0–10)	3 (0–12)
Total ACB^c score ≥3	N = 109	N = 94	N = 15	.001
No. (%) Yes	19 (17.4)	12 (12.8)	7 (46.7)
Polypharmacy	N = 109	N = 94	N = 15
No. (%) Yes	26 (23.9)	19 (20.2)	7 (46.7)	.026
Number of drugs	8.0 ± 2.9	7.6 ± 2.8	9.3 ± 3.1	.045^c

Notes: Group I includes the subjects with SCD who did not progress dementia and group II includes the subjects with SCD who progressed to dementia.

^aAbbreviations: SCD, subjective cognitive decline; MMSE, Mini Mental State Examination; YGDS, Yesavage Geriatric Depression Scale; and ACB, anticholinergic cognitive burden.

^bIndependent sample t-test.

^cMann–Whitney U.

^dOther: alone, relative, caregiver or nursing home.

^eMissing values: Education (2), smoking status (1), alcohol status (1), physical activity (1), depression (4), MMSE (2), and YGDS (4).

Table 2. Predictors of dementia in patients with SCD^a based on univariate and multivariate Cox regression analysis.

		Unadjusted HR^a	95% CI^a	p	Adjusted HR^b	95% CI	p
Age	65–74	1			1
	75–84	3.595	1.117–11.574	.032	2.625	0.773–8.918	.122
	85+	12.203	2.889–51.537	.001	11.468	2.672–49.225	.001
Gender	Female	1
	Male	1.796	0.650–4.957	.259
Smoking	No	1
	Yes	2.454	0.548–10.998	.241
Hypertension	No	1
	Yes	7.835	1.020–60.189	.048
Diabetes mellitus	No	1
	Yes	2.235	0.786–6.354	.131
Total ACB^a score ≥3	No	1
	Yes	4.167	1.507–11.519	.006	4.179	1.430–12.212	.009
Polypharmacy	No	1
	Yes	2.250	0.813–6.229	.119

^aAbbreviations: SCD, subjective cognitive decline; ACB, anticholinergic cognitive burden; HR, hazard ratio; and CI, confidence interval.

^bIt was used a backward stepwise elimination of variables including age, gender, smoking, hypertension, diabetes mellitus, total ACB score ≥3, and polypharmacy.

Table 3. Frequencies of drugs with anticholinergic properties in all subjects (N = 109).

Drugs (anticholinergic score)	N (%)^a
Total	70 (100.0)
Metoprolol (1)	20 (28.6)
Trazodone (1)	15 (21.4)
Trospium (3)	9 (12.9)
Paroxetine (3)	5 (7.1)
Isosorbide (1)	4 (5.7)
Furosemide (1)	3 (4.4)
Nifedipine (1)	3 (4.4)
Colchicine (1)	2 (2.9)
Alprazolam (1)	1 (1.4)
Atenolol (1)	1 (1.4)
Carbamazepine (2)	1 (1.4)
Digoxin (1)	1 (1.4)
Fluvoxamine (1)	1 (1.4)
Levosetirizine (1)	1 (1.4)
Oxybutinine (3)	1 (1.4)
Theophylline (1)	1 (1.4)
Warfarin (1)	1 (1.4)

^aValues are number (%).

Table 4. Frequencies of drugs with anticholinergic properties in subjects with a total ACB^a score ≥ 3 (N = 19).

Drugs (anticholinergic score)	N (%)^b
Total	31 (100.0)
Trospium (3)	9 (29.0)
Metoprolol (1)	5 (16.2)
Paroxetine (3)	5 (16.2)
Trazodone (1)	5 (16.2)
Alprazolam (1)	1 (3.2)
Carbamazepine (2)	1 (3.2)
Isosorbide (1)	1 (3.2)
Nifedipine (1)	1 (3.2)
Oxybutinine (3)	1 (3.2)
Theophylline (1)	1 (3.2)
Warfarin (1)	1 (3.2)

^aAbbreviation: ACB, anticholinergic cognitive burden.

^bValues are number (%).