Long-term exposure to anticholinergic and sedative medications and cognitive and physical function in later life

Hans Wouters, Sarah N Hilmer, Danijela Gnjidic, Jos P Van Campen, Martina Teichert, Helene G Van Der Meer, Laura A Schaap, Martijn Huisman, Hannie C Comijs, Petra Denig, Claudine J Lamoth, Katja Taxis

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21 Citations (Scopus)


Background: Anticholinergic and sedative medications are frequently prescribed to older individuals. These medications are associated with short-term cognitive and physical impairment, but less is known about long-term associations. We therefore examined over twenty years whether cumulative exposure to these medications was related to poorer cognitive and physical functioning.

Methods: Older adult participants of the Longitudinal Aging Study Amsterdam (LASA) were followed from 1992-2012. On 7 measurement occasions, cumulative exposure to anticholinergic and sedative medications was quantified with the Drug Burden Index (DBI), a linear additive pharmacological dose-response model. Cognitive functioning was assessed with the Mini Mental State Examination (MMSE), Alphabet Coding Task (ACT, 3 trials), Auditory Verbal Learning Test (AVLT, learning and retention condition), and Raven Colored Progressive Matrices (RCPM, 2 trials). Physical functioning was assessed with the Walking Test (WT), Cardigan Test (CT), Chair Stands Test (CST), Balance Test (BT), and self-reported Functional Independence (FI). Data were analyzed with linear mixed models adjusted for age, education, sex, living with a partner, BMI, depressive symptoms, co-morbidities (cardiovascular disease, diabetes, cancer, COPD, osteoarthritis, CNS diseases), and prescribed medications.

Results: Longitudinal associations were found of the DBI with poorer cognitive functioning (less items correct on the 3 ACT trials, AVLT learning condition, and the 2 RCPM trials) and with poorer physical functioning (longer completion time on the CT, CST, and lower self-reported FI).

Conclusions: This longitudinal analysis of data collected over 20 years, showed that higher long-term cumulative exposure to anticholinergic and sedative medications was associated with poorer cognitive and physical functioning.

Original languageEnglish
Pages (from-to)357-365
Number of pages9
JournalThe Journals of Gerontology. Series A : Biological Sciences and Medical Sciences
Issue number2
Early online date21 Jan 2019
Publication statusPublished - 1 Feb 2020


  • Anti-muscarinics
  • Benzodiazepines
  • Mobility impairment
  • Neuropsychology
  • Polypharmacy

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