Abstract
ObjectivesTo examine whether anticholinergic medication exposure in middle and late life is associated with physical capability. Study designWe used data from 8477 men and women who had enrolled in the European Prospective Investigation of Cancer-Norfolk study at baseline (1HC; 1993–1997) and who had attended its third health examination (3HC; 2004–2010). Medication history at the 1HC and 3HC was used to score participants according to the Anticholinergic Cognitive Burden (ACB) Scale at baseline and 3HC; participants were categorised as ACB = 0, ACB = 1, ACB>2. Main outcome measureAt 3HC, physical capability was objectively measured by: usual walking speed, maximum grip strength, timed chair stands speed (TCSS) and standing balance. Linear and logistic regression models examined prospective and cross-sectional associations between ACB and physical capability, controlling for co-morbidity, sociodemographic and lifestyle factors. ResultsThe analyses included 3386 men and 4110 women who were 56.4 (SD 7.9) and 55.0 (7.7) years old respectively at baseline and 69.4 (8.1) and 67.9 (8.0) years old at follow-up. Significant cross-sectional and prospective relationships were observed for all physical capability measures in women, except grip strength. For example, women with ACB ≥ 2 compared with ACB = 0 at baseline had 0.07 m/s (95 % CI -0.11, -0.03) slower usual walking speed, 2.61 stands/min (-4.17, -1.05) slower TCSS and higher odds of being unable to complete a tandem stand (odds ratio 2.40, 95 % CI 1.53, 3.76). These trends were observed in men but were less consistent in prospective analyses. ConclusionExposure to anticholinergic medication predicts poor physical capability and is a potentially reversible risk factor.
Highlights
Many commonly prescribed medications such as anti-emetics, antihistamines and tricyclic antidepressants are known to have anticholinergic properties
Similar trends were observed between Anticholinergic Cognitive Burden (ACB) categories and co-variables measured at baseline and between ACB categories at baseline and physical capability measured over a decade later (Supplementary Data, Table 1)
Baseline ACB category was independently associated with higher odds of women being unable to participate in the timed chair stands speed (TCSS) test at the 3HC (ACB = 1 OR 1.93, 95 % CI 1.34, 2.77; ACB ≥ 2 OR 1.81, 95 % CI 1.13, 2.89). To our knowledge this is the first study to investigate the association between anticholinergic medication exposure and physical capability in a cohort of men and women spanning a wide age-range, originally sampled from the general population
Summary
Many commonly prescribed medications such as anti-emetics, antihistamines and tricyclic antidepressants are known to have anticholinergic properties. 20–50 % of older adults have a prescription for at least one such medication and, in the UK, the proportion of older people prescribed anticholinergic medications has steadily increased over the last few years [1,2]. This trend is worrying considering emerging evidence that anticholinergic medication exposure is associated with adverse health outcomes. Exposure to anticholinergic medications has been associated with late-life cognitive impairment, higher risk of falls and incident stroke [3,4,5].
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