Objective: To evaluate baseline predictors and longitudinal impact of anticholinergics use in Parkinson’s disease (PD).

Background: Anticholinergics have beneficial effect on tremor in PD but are known to have adverse impact on cognition in the elderly. Less clear, is the long-term impact of their use in PD.

Methods: Data were obtained from the NPF-QII database, an observational prospective longitudinal study, conducted at 21 NPF sites, with all PD patients eligible for enrollment. Data included demographics, comorbid conditions, PD stage/diagnosis, other treatments, and clinical conditions/outcomes. The baseline characteristics were compared for anticholinergic users versus nonusers. To assess long-term impact of anticholinergic use, newly prescribed users of anticholinergics were compared to nonusers using a generalized linear mixed model to regress each clinical outcome on the time-dependent “anticholinergic use” variable while adjusting for age, disease duration, Hoehn and Yahr (HY) stage, and initial score of outcome of interest.

Results: 7484 patients were included in the baseline dataset. Anticholinergic users were more likely to be younger, able to stand unaided, have a regular care partner, have an earlier age of PD diagnosis/symptoms, have a higher HY stage, have no motor fluctuations, not be on some form of levodopa, have better cognition level, and have fewer comorbid conditions. 4334 patients who had more than one visit were included in the longitudinal analysis. The mean follow up was 2.39 (SD 1.09) years. 160 were newly prescribed anticholinergics. Anticholinergic users had a lower scores on the cognitive recall test (-0.613%, t = -2.19, P= 0.0286), but no change in the total PDQ-39 or PDQ-39 cognition subscore.

Conclusions: As expected, patients prescribed anticholinergics tend to be younger, have an earlier PD diagnosis and be overall healthier. However, even in that selected subset of PD patients, long term use of anticholinergics is associated with a decrease in cognitive performance. Physicians should be vigilant of the long term negative cognitive effects of anticholinergics in PD although more data are necessary to assess whether the effect is permanent or reversible.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/utilization-and-longitudinal-impact-of-anticholinergic-use-in-parkinsons-disease-national-parkinson-foundation-npf-qii-registry/