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Long-term anticholinergic use and the aging brain
Cai X, Campbell N, Khan B, Callahan C, Boustani M.. Alzheimer's & dementia : the journal of the Alzheimer's Association, 2012-11-22
Topic: Risk, prevention and care in population studies
Background Older Americans are facing an epidemic of chronic diseases and are thus exposed to anticholinergics (ACs) that might negatively affect their risk of developing mild cognitive impairment (MCI) or dementia. Objective To investigate the association between impairment in cognitive function and previous AC exposure. Design A retrospective cohort study. Setting Primary care clinics in Indianapolis, Indiana. Participants A total of 3690 older adults who have undergone cognitive assessment and had a 1-year medication-dispensing record. Outcome Cognitive function was measured in two sequential steps: a two-step screening process followed by a formal diagnostic process for participants with positive screening results. Exposure Three patterns of AC exposure were defined by the duration of AC exposure, the number of AC medications dispensed at the same time, and the severity of AC effects as determined by the Anticholinergic Cognitive Burden list. Results Compared with older adults with no AC exposure and after adjusting for age, race, gender, and underlying comorbidity, the odds ratio for having a diagnosis of MCI was 2.73 (95% confidence interval, 1.27-5.87) among older adults who were exposed to at least three possible ACs for at least 90 days; the odds ratio for having dementia was 0.43 (95% confidence interval, 0.10-1.81). Conclusion Exposure to medications with severe AC cognitive burden may be a risk factor for developing MCI.
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APA 7th
Cai, X., Campbell, N., Khan, B., Callahan, C., & Boustani, M. (2013). Long-term anticholinergic use and the aging brain. Alzheimer's & dementia : the journal of the Alzheimer's Association. https://doi.org/10.1016/j.jalz.2012.02.005
Vancouver
Cai X, Campbell N, Khan B, Callahan C, Boustani M. Long-term anticholinergic use and the aging brain. Alzheimer's & dementia : the journal of the Alzheimer's Association. 2013. doi:10.1016/j.jalz.2012.02.005. PMID: 23183138.
BibTeX
@article{cai2013-23183138,
author = {Cai, X. and Campbell, N. and Khan, B. and Callahan, C. and Boustani, M.},
title = {{Long-term anticholinergic use and the aging brain}},
journal = {Alzheimer's \& dementia : the journal of the Alzheimer's Association},
year = {2013},
doi = {10.1016/j.jalz.2012.02.005},
pmid = {23183138},
url = {https://doi.org/10.1016/j.jalz.2012.02.005}
}
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Key findings
- Outcome Cognitive function was measured in two sequential steps: a two-step screening process followed by a formal diagnostic process for participants with positive screening results.
- Results Compared with older adults with no AC exposure and after adjusting for age, race, gender, and underlying comorbidity, the odds ratio for having a diagnosis of MCI was 2.73 (95% confidence interval, 1.27-5.87) among older adults who were exposed to at least three possible ACs for at least 90 days; the odds ratio for having dementia was 0.43 (95% confidence interval, 0.10-1.81).
Why it matters
This study found that older adults exposed to at least three possible anticholinergic medications for at least 90 days had higher odds of being diagnosed with mild cognitive impairment. It did not find a significant association with dementia diagnosis.
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Study details
- Study designcohort study
- Participants3,690
- Evidence strengthModerate
How this study scored 61/100
Published in a leading specialty journal, and it is a cohort study following people over time. Scored zero for effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Alzheimer's & dementia : the journal of the Alzheimer's Association) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| 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 | 1 / 5 | 2013 — within 20 year(s) of the newest study here |
| Sample size | 3 / 4 | 3,690 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 193 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 12.9 citations a year over 15 year(s) since 2013 |
| Impact for its field and year | 3 / 6 | Cited 4.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 8 other studies in this library |
| Still being cited | 2 / 4 | Cited 35 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Malaz A. Boustani: h-index 65 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Iowa: institution h-index 1,080 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 23183138) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 61 / 100 | — |
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Read the original
- DOI: 10.1016/j.jalz.2012.02.005
- PubMed: 23183138
- Original source →
- Free full text: IUScholarWorks (Indiana University) →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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