Cognitive decline in older persons initiating anticholinergic medications

PLoS One. 2013 May 31;8(5):e64111. doi: 10.1371/journal.pone.0064111. Print 2013.


Background: This study examines the effect of initiating medications with anticholinergic activity on the cognitive functions of older persons.

Methods: Participants were 896 older community-dwelling, Catholic clergy without baseline dementia. Medication data was collected annually. The Anticholinergic Cognitive Burden Scale was utilized to identify use of a medication with probable or definite anticholinergic activity. Participants had at least two annual cognitive evaluations.

Results: Over a mean follow-up of 10 years, the annual rate of global cognitive function decline for never users, prevalent users, and incident users was -0.062 (SE = 0.005), -0.081(SE = 0.011), and -0.096 (SE = 0.007) z-score units/year, respectively. Compared to never users, incident users had a more rapid decline (difference = -0.034 z-score units/year, SE = 0.008, p<0.001) while prevalent users did not have a significantly more rapid decline (p = 0.1).

Conclusions: Older persons initiating a medication with anticholinergic activity have a steeper annual decline in cognitive functioning than those who are not taking these medications.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Catholicism
  • Cholinergic Antagonists / adverse effects*
  • Clergy
  • Cognition / drug effects*
  • Cognition Disorders / drug therapy
  • Cognition Disorders / physiopathology*
  • Cognition Disorders / psychology
  • Drug Administration Schedule
  • Female
  • Humans
  • Language Tests
  • Male
  • Psychological Tests
  • Risk Factors
  • Severity of Illness Index


  • Cholinergic Antagonists