THE ASSOCIATION BETWEEN ANTICHOLINERGIC MEDICINE AND COGNITION DECLINE IN OLDER ADULTS- A SYSTEMIC REVIEW AND META-ANALYSIS
Author(s)
Yang DC1, Hsu JC2
1National Cheng Kung University Hospital, Tainan, Taiwan, 2National Cheng Kung University, College of Medicine, Tainan, Taiwan
Presentation Documents
OBJECTIVES : Some randomized clinical trials indicated the increasing risk of cognition decline by anticholinergic medicine, while the association did not found by other clinical trials. The meta-analysis studies have been made by scholars, but this controversy has not been resolved by them. The goal of this systemic review and meta-analysis was to confirm the association between anticholinergic medicine and cognition decline in older adults by using additional RCTs and further analyses. METHODS : Following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA), electronic databases (clinicaltrials.gov website, PubMed and Cochrane) were searched for all clinical trials and observational studies till May 2019. The outcome of interest was cognition decline in older adults with anticholinergic medicine exposure. The JADAD quality score was applied to evaluate bias in randomized controlled trials (RCTs). Heterogeneity was assessed using I2 tests. Subgroup analysis was furtherly performed. RCTs were divided into 2 subgroups as inpatient/outpatient individuals and nursing home residents. Publication bias was assessed using Funnel plot. RESULTS : A total of 7 RCTs with 225 patients were included in this meta-analysis. Because mini-mental state examination was only reported in 5 of 7 RCTs, the meta-analysis was performed based on these 5 RCTs. Both of fixed effect and random effect were performed, and the results showed no association between anticholinergic medicine exposure and cognition decline (fixed effect: MD 0.291, 95% C.I. 0.019 to 0.562, p=0.036; random effect: MD 0.296, 95% C.I. -0.412 to 1.005, p=0.413). High heterogeneity among studies (I2=84.94%) were found, and subgroup analysis was performed. Heterogeneity among studies with inpatient/outpatient individuals was low (I2=20.45%), but it was high among studies with nursing home residents (I2=88.28%). CONCLUSIONS : In conclusion, the present study did not find the association between anticholinergic medicine exposure and cognition decline in older adults.
Conference/Value in Health Info
2019-11, ISPOR Europe 2019, Copenhagen, Denmark
Code
PIH34
Topic
Clinical Outcomes, Epidemiology & Public Health
Topic Subcategory
Clinical Outcomes Assessment, Performance-based Outcomes, Safety & Pharmacoepidemiology
Disease
Geriatrics