Long-term exposure to anticholinergic and sedative drugs and cognitive and physical function in later life

Introduction: Anticholinergic and sedative drugs from various therapeutic classes are frequently prescribed to older people. These drugs are known to impair cognitive and physical function in the short-term. However, long-term exposure to these drugs remains less examined. Methods: Data from the Longitudinal Aging Study Amsterdam, a Dutch nationally representative cohort study, collected over twenty years (1992-2012) at seven occasions, were analyzed. On each occasion, cumulative exposure to anticholinergic and sedative drugs was quantified with the Drug Burden Index (DBI), a linear additive pharmacological dose-response model. The relationships between the DBI and outcomes of cognitive function (MMSE, Alphabet Coding Task, 15-Words Test) and physical function (Walking Test, Chair Stands Test, Cardigan Test, and Functional Independence Scale) were examined using linear mixed models adjusted for sex, marital status, age, education, smoking status, drugs not included in DBI, body mass index, depression, and co-morbidities. Results: At baseline, there were 2896 individuals (52% women; mean age 70±9 years). Of them, 62% had no exposure to anticholin-ergic and sedative drugs (DBI=0), 24% moderate exposure (DBI =0-1), and 14% high exposure (DBI >1). Significant independent associations were found between the DBI and physical function (Walking Test log transformed: B=0.02 [95% CI: 0.01; 0.03], Cardigan Test log transformed: B=0.02 [95% CI: 0.01; 0.03], Chair Stands Test B=0.48 [95% CI: 0.20; 0.76], and Functional Independence: B=-0.89 [95% CI:-1.22;-0.55]). No associations were found between the DBI and cognitive function. Conclusions: Over 20 years, higher anticholinergic and sedative exposure is associated with poorer physical but not poorer cognitive function.