R2D2

STUDY DATES: 05/01/2019 – 03/31/2024

As many as 30% of older adults use a medication that increases the risk of Alzheimer’s disease and related dementias (ADRD), however no study has yet tested whether stopping anticholinergics in current users results in improved and sustained benefit on cognition.

This proposal will conduct a randomized trial to determine if a pharmacist-based, anticholinergic de-prescribing intervention improves cognition and lowers the risk of ADRD in primary care older adults with subjective cognitive dysfunction. Safety measures for disease severity and quality of life will complement the cognitive outcomes in the 24 month duration of the study.

Campbell NL, Holden RJ, Boustani MA. Preventing Alzheimer’s disease by deprescribing anticholinergic medications. JAMA Intern Med 2019; 179(8):1093-1094.

Campbell NL, Solid CA, Boustani MA. Anticholinergics and dementia: the importance of patient education. Aging Today 2018;39:5.

Richardson K, Fox C, Maidment I, Steel N, Loke YK, Arthur A, Myint PK, Grossi C, Mattishent K, Bennett K, Campbell NL, Boustani M, Robinson L, Brayne C, Matthews F, Savva G. The association between up to 20 year history of anticholinergic medication use and dementia incidence varies by drug class: A nested case-control study using the Clinical Practice Research Datalink. BMJ 2018; Apr 25;361:k1315. doi: 10.1136/bmj.k1315. PMID: 29695481.

Campbell NL, Lane KA, Gao S, Boustani M, Unverzagt F. Anticholinergics increase transition
from normal cognition to mild cognitive impairment in community-dwelling older adults. Pharmacotherapy 2018 May;38(5):511-519. doi: 10.1002/phar.2106. Epub 2018 Apr 25.
PMID: 29600808. https://doi.org/10.1002/phar.2106.

Campbell NL, Perkins AJ, Bradt P, Perk S, Wielage R, Boustani M, Ng D. The association of anticholinergic burden with cognitive impairment and healthcare utilization. Pharmacotherapy 2016;36(11):1123-1131.

Campbell N, Boustani M, Lane K, Gao S, Hendrie H, Khan B, Murrell J, Unverzagt F, Hake A, Smith-Gamble V, Hall D. Use of anticholinergics and the risk of cognitive impairment in an African-American population. Neurology 2010;75:152-159.