The effect of anticholinergic medications on cognitive function of patients 80 years and older with essential hypertension

Background. Cognitive impairment and dementia are the symptoms of brain damage in hypertension (HTN), which impair quality of life and autonomy, in particular, in elderly patients. However, the influence of various drugs on the cognitive functions remains unclear.

Objective. To assess the effect of anticholinergic drugs on cognitive functions in hypertensive patients aged 80 years and older.

Design and methods. We consistently included 74 patients (77 % women) aged 80 years and older (median age 86 [82-89] years) with essential HTN stage I—III, who were admitted to the Department of Internal Diseases at the multidisciplinary hospital. Inclusion criteria were the following: patients with essential HTN stage I—III of both sexes; 2) age at the time of inclusion in the study — 80 years and older; regular antihypertensive therapy. The main non-inclusion criteria were the following: 1) age less than 80 years; myocardial infarction during the previous 3 months; mental illness, dependence on drugs or alcohol; acute cerebrovascular events during previous 6 months; non-compliance with the study protocol. Each patient underwent the assessment of cognitive status, depression, comprehensive geriatric evaluation. Medical records were studied. When medications were administered, the prescribed anticholinergic (AH) drugs were assessed by the scale of anticholinergic Cognitive Burden (ACB). The following scales and tests were used to evaluate cognitive functions: Mini-mental State Examination (MMSE), Montreal-Cognitive Assessment (MoCA), the Boston naming test (Boston Naming Test (BNT), Category fluency tests, subtest Wechsler Adult Intelligence Scale (WAIS-IV), Digit symbol substitution test (DSST), Word List Test (WLT), Alzheimer’s Disease Assesment Scale — Cognitive (ADAS-cog). Symptoms of depression were assessed using a shortened version of the geriatric Depression Scale (GDS 15).

Results. Based on the AH burden (the ACB scale), the patients were divided into 2 groups: 1^st group included patients who do not take drugs with AH burden (n = 25, 33,8 %), 2^nd group included patients taking drugs with AH burden (n = 49, 66,2 %). Patients who took drugs with AH burden showed a more pronounced decrease in cognitive functions: MMSE (lower overall score: 21 [18—23] and 22,5 [20—26] points, respectively, p = 0.04), number of recognizable images on the Boston test (lower number of the images: 27 [25— 30] and 30 [28—31], respectively, p = 0.014), and the cognitive adas-cog subscale (higher score, 16,7 [12—19,3] and 12,7 [11—14,6], respectively, p = 0.03).

Conclusion. In HTN patients aged 80 years and older, therapy with AH burden is associated with the more profound decrease in cognitive functions.

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