Long-term Exposure To Antic icholi linergic ic And Sedativ ive - PowerPoint PPT Presentation

Long-term Exposure To Antic icholi linergic ic And Sedativ ive Drugs And Cognitiv ive And Physic ical l Functio ion In In Later Lif ife Hans Wouters, Sarah Hilmer, Danijela Gnjidic, Jos Van Campen, Martina Teichert, Heleen Van der Meer, Laura Schaap, Martijn Huisman, Petra Denig, Claudine Lamoth, Katja Taxis

CONFLICT OF INTEREST DISCLOSURE I have no potential conflict of interest to report

Problem definition

Ness et al., 2006, Am J Geriatr Pharm; Johnnell, 2009, Int J Geriatr Psychiatr

Study Aim

Approach

Longitudinal Aging Study Amsterdam (LASA) • A Dutch nationally representative cohort study • Of older community-dwelling adults aged 55- 85 y • Data collection 20 years (1992-2012) at 7 occasions • Men and older people oversampled to counteract selective drop-out • Detailed assessment of drug use including verification with medication containers

D ∑ DBI = D + δ

Outcomes: Cognitive Function: Physical Function: • • MMSE Walking Test • • Alphabet coding task Chair Stands Tests • • 15 Words Test Cardigan Test • Functional Independence Scale

Results

Key data • Number of participants at baseline: N = 2896 • 52% women • Mean age 70.6 (SD 9) • No exposure (61%), moderate exposure (24%) and high exposure (14%) according to DBI: D ∑ • Loss to follow-up: D + δ • 1 st follow-up: N = 2377 • final follow-up: N = 734

Linear Mixed Models: Cognitive Function Regression Coefficients (95% CIs) Outcomes over 20 years DBI 0.09 (-0.07;0.24) NS MMSE score Moderate High -0.03 (-0.22;0.16) NS Alphabet Coding Task: Trial 1 Moderate 0.29 (-0.04;0.62) NS 0.07 (-0.31;0.44) NS High 0.13 (-0.19;0.45) NS Alphabet Coding Task: Trial 2 Moderate High -0.01 (-0.38;0.36) NS Alphabet Coding Task: Trial 3 Moderate 0.17 (-0.14;0.49) NS -0.12 (-0.49;0.25) NS High 0.02 (-0.13;0.16) NS 15 Words Test: Word Learning Moderate High -0.06 (-0.23;0.10) NS 15 Words Test: Delayed Recall Moderate 0.59 (-1.14;2.32) NS 0.79 (-1.08;2.67) NS High * No exposure is the reference

Linear Mixed Models: Physical Function Regression Coefficients * Outcomes over 20 years DBI (95% Confidence Intervals) 0.01 (-0.01;0.01) NS Walking Test Moderate High 0.02 (0.01;0.03) S Cardigan Test Moderate 0.01 (-0.01;0.01) NS 0.02 (0.01;0.03) S High 0.25 (0.00;0.50) NS Chairs Stands Test Moderate High 0.48 (0.20;0.76) S Functional Independence Test Moderate -0.14 (-0.41;0.13) NS -0.89 (-1.22;-0.55) S High * No exposure is the reference

DBI & Physical Function High DBI Moderate DBI No exposure Walking (sec) Cardigan (sec) Time Chair Stands (sec) Functional Independence (Self-report) Time

Conclusions

Conclusion Over 20 years, higher anticholinergic and sedative exposure is associated with poorer physical but not poorer cognitive function.

Challenges • Residual Confounding: reflect on adequacy of covariates • Drug exposure between measurement occasions: conduct relevant sensitivity analyses • Generalizability: the need to study e.g. migrants

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