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Use of anticholinergics and the risk of cognitive impairment in an African American population
Campbell NL, Boustani MA, Lane KA, Gao S, Hendrie H, Khan BA, Murrell JR, Unverzagt FW et al.. Neurology, 2010-07-01
Topic: Risk, prevention and care in population studies
Background Anticholinergic properties of certain medications often go unrecognized, and are frequently used by the elderly population. Few studies have yet defined the long-term impact of these medications on the incidence of cognitive impairment. Methods We report a 6-year longitudinal, observational study, evaluating 1,652 community-dwelling African American subjects over the age of 70 years who were enrolled in the Indianapolis-Ibadan Dementia Project between 2001 and 2007 and who had normal cognitive function at baseline. The exposure group included those who reported the baseline use of possible or definite anticholinergics as determined by the Anticholinergic Cognitive Burden scale. Our main outcome measure was the incidence of cognitive impairment, defined as either dementia or cognitive impairment not dementia, or poor performance on a dementia screening instrument during the follow-up period. Results At baseline, 53% of the population used a possible anticholinergic, and 11% used a definite anticholinergic. After adjusting for age, gender, educational level, and baseline cognitive performance, the number of definite anticholinergics was associated with an increased risk of cognitive impairment (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.07-1.99; p = 0.02), whereas the number of possible anticholinergics at baseline did not increase the risk (OR 0.96, 95% CI 0.85-1.09; p = 0.55). The risk of cognitive impairment among definite anticholinergic users was increased if they were not carriers of the APOE epsilon4 allele (OR 1.77, 95% CI 1.03-3.05; p = 0.04). Conclusions Limiting the clinical use of definite anticholinergics may reduce the incidence of cognitive impairment among African Americans.
Key findings
- Results At baseline, 53% of the population used a possible anticholinergic, and 11% used a definite anticholinergic.
- After adjusting for age, gender, educational level, and baseline cognitive performance, the number of definite anticholinergics was associated with an increased risk of cognitive impairment (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.07-1.99; p = 0.02), whereas the number of possible anticholinergics at baseline did not increase the risk (OR 0.96, 95% CI 0.85-1.09; p = 0.55).
Why it matters
In a 6-year observational study of 1,652 African American adults over 70 who started with normal cognition, each additional *definite* anticholinergic medicine taken at baseline was linked to higher odds of developing cognitive impairment (OR 1.46, 95% CI 1.07–1.99), after adjusting for age, gender, education and baseline cognition. Medicines with only *possible* anticholinergic activity, used by 53% of participants, showed no such link (OR 0.96). This shows an association, not proof of cause. The study did not test stopping any drug, so medication changes should be discussed with a prescriber.
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Study details
- Study designlongitudinal study
- Effect sizeOR 0.96; OR 1.77
- Evidence strengthModerate
How this study scored 60/100
Published in a leading specialty journal, and it is a longitudinal study following the same people over time. Scored zero for sample size, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Neurology) |
| Journal's citation record | 4 / 4 | Neurology: journal h-index 525 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A longitudinal study following the same 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 | 2010 — within 20 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 | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| 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 | 5 / 7 | Cited 188 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 10.4 citations a year over 18 year(s) since 2010 |
| Impact for its field and year | 3 / 6 | Cited 3.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 6 other studies in this library |
| Still being cited | 2 / 4 | Cited 33 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Kathleen Steele Hall: h-index 54 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Indiana University School of Medicine: institution h-index 784 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 20625168) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 60 / 100 | — |
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Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Campbell, N. L., Boustani, M. A., Lane, K. A., Gao, S., Hendrie, H., Khan, B. A., et al. (2010). Use of anticholinergics and the risk of cognitive impairment in an African American population. Neurology. https://doi.org/10.1212/wnl.0b013e3181e7f2ab
Vancouver
Campbell NL, Boustani MA, Lane KA, Gao S, Hendrie H, Khan BA, et al. Use of anticholinergics and the risk of cognitive impairment in an African American population. Neurology. 2010. doi:10.1212/wnl.0b013e3181e7f2ab. PMID: 20625168.
BibTeX
@article{campbell2010-20625168,
author = {Campbell, N. L. and Boustani, M. A. and Lane, K. A. and Gao, S. and Hendrie, H. and Khan, B. A. and Murrell, JR. and Unverzagt, F. W. and others},
title = {{Use of anticholinergics and the risk of cognitive impairment in an African American population}},
journal = {Neurology},
year = {2010},
doi = {10.1212/wnl.0b013e3181e7f2ab},
pmid = {20625168},
url = {https://doi.org/10.1212/wnl.0b013e3181e7f2ab}
}
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