Long-term Exposure To Antic icholi linergic ic And Sedativ ive - - PowerPoint PPT Presentation

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Feb 05, 2023 708 likes •906 views

Long-term Exposure To Antic icholi linergic ic And Sedativ ive Drugs And Cognitiv ive And Physic ical l Functio ion In In Later Lif ife Hans Wouters, Sarah Hilmer, Danijela Gnjidic, Jos Van Campen, Martina Teichert, Heleen Van der

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Long-term Exposure To Antic icholi linergic ic And Sedativ ive Drugs And Cognitiv ive And Physic ical l Functio ion In In Later Lif ife

Hans Wouters, Sarah Hilmer, Danijela Gnjidic, Jos Van Campen, Martina Teichert, Heleen Van der Meer, Laura Schaap, Martijn Huisman, Petra Denig, Claudine Lamoth, Katja Taxis

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CONFLICT OF INTEREST DISCLOSURE I have no potential conflict

f interest to report

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Problem definition

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Ness et al., 2006, Am J Geriatr Pharm; Johnnell, 2009, Int J Geriatr Psychiatr

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Study Aim

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Approach

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A Dutch nationally representative cohort study
Of older community-dwelling adults aged 55-

85 y

Data collection 20 years (1992-2012) at 7
ccasions
Men and older people oversampled to

counteract selective drop-out

Detailed assessment of drug use including

verification with medication containers

Longitudinal Aging Study Amsterdam (LASA)

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DBI = ∑ D D + δ

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Physical Function:

Walking Test
Chair Stands Tests
Cardigan Test
Functional Independence

Scale

Outcomes:

Cognitive Function:

MMSE
Alphabet coding task
15 Words Test

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Results

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Key data

Number of participants at baseline: N = 2896
52% women
Mean age 70.6 (SD 9)
No exposure (61%), moderate exposure (24%) and high

exposure (14%) according to DBI:

Loss to follow-up:
1st follow-up: N = 2377
final follow-up: N = 734

∑ D D + δ

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Linear Mixed Models: Cognitive Function

Outcomes over 20 years DBI Regression Coefficients (95% CIs) MMSE score Moderate

0.09 (-0.07;0.24) NS

High

0.03 (-0.22;0.16) NS

Alphabet Coding Task: Trial 1 Moderate

0.29 (-0.04;0.62) NS

High

0.07 (-0.31;0.44) NS

Alphabet Coding Task: Trial 2 Moderate

0.13 (-0.19;0.45) NS

High

0.01 (-0.38;0.36) NS

Alphabet Coding Task: Trial 3 Moderate

0.17 (-0.14;0.49) NS

High

0.12 (-0.49;0.25) NS

15 Words Test: Word Learning Moderate

0.02 (-0.13;0.16) NS

High

0.06 (-0.23;0.10) NS

15 Words Test: Delayed Recall Moderate

0.59 (-1.14;2.32) NS

High

0.79 (-1.08;2.67) NS

* No exposure is the reference

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Linear Mixed Models: Physical Function

Outcomes over 20 years DBI Regression Coefficients * (95% Confidence Intervals) Walking Test Moderate

0.01 (-0.01;0.01) NS

High

0.02 (0.01;0.03) S

Cardigan Test Moderate

0.01 (-0.01;0.01) NS

High

0.02 (0.01;0.03) S

Chairs Stands Test Moderate

0.25 (0.00;0.50) NS

High

0.48 (0.20;0.76) S

Functional Independence Test Moderate

0.14 (-0.41;0.13) NS

High

0.89 (-1.22;-0.55) S

* No exposure is the reference

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DBI & Physical Function

Walking (sec) Time Time High DBI Moderate DBI No exposure Functional Independence (Self-report) Cardigan (sec) Chair Stands (sec)

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Conclusions

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Over 20 years, higher anticholinergic and sedative exposure is associated with poorer physical but not poorer cognitive function.

Conclusion

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Residual Confounding:

reflect on adequacy of covariates

Drug exposure between measurement occasions:

conduct relevant sensitivity analyses

Generalizability:

the need to study e.g. migrants

Challenges

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Thank you

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