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Concomitant Cholinesterase Inhibitor and Anticholinergic Drug Use Among Older Adults With Dementia
Elizabeth Jeanne Carter, Erwin J. Tan. Innovation in Aging, 2020-12-01
Topic: Risk, prevention and care in population studies
Abstract Anticholinergic medications (ACh) are frequently prescribed to older adults despite being associated with impaired physical functioning. Moreover, the concomitant use of ACh and cholinesterase inhibitors (ChEI) reduces the body’s response to both drugs, thereby diminishing the modest effectiveness of ChEI at slowing the progression of dementia symptoms. The objective of this study was to assess the risk of concomitant ACH/ChEI use on functional outcomes, including fall, fracture, and traumatic brain injury (TBI). We conducted a retrospective review of data from the OptumLabs® Data Warehouse, a de-identified administrative claims database for commercially insured and Medicare Advantage (MA) enrollees, representing a diverse mixture of ages, ethnicities, and geographical regions across the U.S. Our cohort included adults 65 and older enrolled in MA between 1998 and 2017. Subjects were required to have dementia (by a diagnosis and/or prescription for a dementia drug (memantine or ChEI)) and at least one claim for ChEI during 12 months of follow-up. Subjects had to be enrolled in MA 6 months prior to the dementia index date. We defined concomitant ACh/ChEI use as an overlap of 30 days or more. Nearly one-third (29%) were concomitantly prescribed ACh and ChEI. Half (51%) of concomitant users were prescribed ChEI first, 46% were prescribed ACh first, and 3% received prescriptions on the same day. Results from multiple logistic regression analyses show that older adults with dementia who had concomitant ACh/ChEI use were 18%, 16%, and 25% more likely to experience a fall, fracture, or TBI, respectively, than those taking ChEI alone.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Carter, E. J., & Tan, E. J. (2020). Concomitant Cholinesterase Inhibitor and Anticholinergic Drug Use Among Older Adults With Dementia. Innovation in Aging. https://doi.org/10.1093/geroni/igaa057.842
Vancouver
Carter EJ, Tan EJ. Concomitant Cholinesterase Inhibitor and Anticholinergic Drug Use Among Older Adults With Dementia. Innovation in Aging. 2020. doi:10.1093/geroni/igaa057.842.
BibTeX
@article{carter2020-26f00cc1,
author = {Carter, Elizabeth Jeanne and Tan, Erwin J.},
title = {{Concomitant Cholinesterase Inhibitor and Anticholinergic Drug Use Among Older Adults With Dementia}},
journal = {Innovation in Aging},
year = {2020},
doi = {10.1093/geroni/igaa057.842},
url = {https://doi.org/10.1093/geroni/igaa057.842}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Key findings
- Abstract Anticholinergic medications (ACh) are frequently prescribed to older adults despite being associated with impaired physical functioning.
- Results from multiple logistic regression analyses show that older adults with dementia who had concomitant ACh/ChEI use were 18%, 16%, and 25% more likely to experience a fall, fracture, or TBI, respectively, than those taking ChEI alone.
Why it matters
Nearly one-third of older adults with dementia taking cholinesterase inhibitors were also prescribed anticholinergic drugs, and this concomitant use was linked to 18% more falls, 16% more fractures and 25% more traumatic brain injuries. The finding concerns avoiding a harmful drug combination that reduces the modest symptom-slowing effect of cholinesterase inhibitors, not curing or preventing dementia.
Study details
- Evidence strengthModerate
How this study scored 26/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Innovation in Aging) |
| Journal's citation record | 0 / 4 | Innovation in Aging: journal h-index 48 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2020 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 8 year(s) since 2020 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Erwin J. Tan: h-index 15 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | AARP: institution h-index 139 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Total | 26 / 100 | — |
What each of these 20 components measures, and what this score is not →
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