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Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study

BMJ 2006; 332 doi: (Published 23 February 2006) Cite this as: BMJ 2006;332:455
  1. Marie L Ancelin, senior research fellow1,
  2. Sylvaine Artero, research fellow1,
  3. Florence Portet, assistant professor1,
  4. Anne-Marie Dupuy, assistant professor1,
  5. Jacques Touchon, professor1,
  6. Karen Ritchie, research director (ritchie{at}
  1. 1 Inserm, E361, Pathologies of the Nervous System, 34093 Montpellier, France
  1. Correspondence to: K Ritchie, Inserm E361, Hôpital La Colombière, Pav 42, 39 Avenue Flahault, BP 34493, 34093 Montpellier Cedex 5, France
  • Accepted 17 November 2005


Objective To assess the potential of anticholinergic drugs as a cause of non-degenerative mild cognitive impairment in elderly people.

Design Longitudinal cohort study.

Setting 63 randomly selected general practices in the Montpellier region of southern France.

Participants 372 people aged > 60 years without dementia at recruitment.

Main outcome measures Anticholinergic burden from drug use, cognitive examination, and neurological assessment.

Results 9.2% of subjects continuously used anticholinergic drugs during the year before cognitive assessment. Compared with non-users, they had poorer performance on reaction time, attention, delayed non-verbal memory, narrative recall, visuospatial construction, and language tasks but not on tasks of reasoning, immediate and delayed recall of wordlists, and implicit memory. Eighty per cent of the continuous users were classified as having mild cognitive impairment compared with 35% of non-users, and anticholinergic drug use was a strong predictor of mild cognitive impairment (odds ratio 5.12, P = 0.001). No difference was found between users and non-users in risk of developing dementia at follow-up after eight years.

Conclusions Elderly people taking anticholinergic drugs had significant deficits in cognitive functioning and were highly likely to be classified as mildly cognitively impaired, although not at increased risk for dementia. Doctors should assess current use of anticholinergic drugs in elderly people with mild cognitive impairment before considering administration of acetylcholinesterase inhibitors.


  • Contributors The first two authors, MLA and SA, contributed equally to this work. KR is guarantor. All authors participated in analysis and interpretation of data, drafting or revising the article, and all have given final approval to be published.

  • Funding Financial support for the Eugeria project was given by the French Social Security (CNAM-TS), the Fondation de France, the Direction Générale de la Santé, and the Region Languedoc Roussillon.

  • Competing interests None declared.

  • Ethical approval Authorisation for the study was obtained from the national data protection committee (CNIL) and the national ethics committee.

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