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.

In the absence of an effective clinical treatment for age-related neurodegenerative disorder, research has focused on the identification of potential risk factors in order to delay cognitive decline and prolong autonomy. Reversible drug-induced cognitive impairment has been described in clinical studies of patients with cognitive impairment or neuropsychiatric disorder. They have generally focused on acute (single-dose) or short-term administration of anticholinergic medication and delirium.¹ Few community studies have, however, been undertaken despite the relatively high intake of over-the-counter and prescription drugs consumed by elderly patients.² Several cross-sectional studies in elderly persons have demonstrated a link between anticholinergic medication and global cognitive functioning,^3-6 psychomotor speed,^7,8 visual and declarative memory,⁴ and implicit learning.⁷ The causal relationship between long-term use of anticholinergics and subclinical cognitive decline thus remains unclear owing to the scarcity of longitudinal population studies. In a retrospective study of 592 older adults, Bottiggi et al⁹ observed an accelerated decline over a 6-year period of psychomotor speed and executive functioning in anticholinergic users. In a sample of 372 elderly participants, we previously reported¹⁰ an important association between continuous anticholinergic use for 1 year and poorer performance on specific cognitive domains. Most important, anticholinergic drug use was observed to be a strong predictor of mild cognitive impairment (MCI), although the risk of subsequent dementia could not be estimated owing to small numbers of patients with dementia. Very recently, in a cohort of 544 community-dwelling older men with hypertension, cumulative anticholinergic exposure was shown to be associated with poor performance on verbal memory over 2 years.¹¹

Objective: To examine the association between caffeine intake, cognitive decline, and incident dementia in a community-based sample of subjects aged 65 years and over.

Study Objectives:. Previous studies have reported that insomnia and excessive daytime sleepiness (EDS) may predict depression in adults. However, these

Changes in criteria and differences in populations studied and methodology have produced a wide range of prevalence estimates for mild cognitive impairment (MCI). Uniform criteria were applied to harmonized data from 11 studies from USA, Europe, Asia and Australia, and MCI prevalence estimates determined using three separate definitions of cognitive impairment. The published range of MCI prevalence estimates was 5.0%–36.7%. This was reduced with all cognitive impairment definitions: performance in the bottom 6.681% (3.2%–10.8%); Clinical Dementia Rating of 0.5 (1.8%–14.9%); Mini-Mental State Examination score of 24–27 (2.1%–20.7%). Prevalences using the first definition were 5.9% overall, and increased with age (P < .001) but were unaffected by sex or the main races/ethnicities investigated (Whites and Chinese). Not completing high school increased the likelihood of MCI (P ≤ .01). Applying uniform criteria to harmonized data greatly reduced the variation in MCI prevalence internationally.

Background: France has high rates of psychotropic drug consumption and suicide in the elderly population, but it has not yet been possible to determine whether this is due to exceptionally high morbidity rates.Aims: To describe the first longitudinal population study of psychiatric disorder undertaken in France, and to estimate current and lifetime prevalences and age of onset of psychiatric disorder.Method: A study group of 1873 non-institutionalised persons aged 65 years and over was randomly recruited from the Montpellier district electoral rolls. The Mini International Neuropsychiatric Interview was used to assess current and lifetime symptoms. Cases identified by the application of DSM–IV criteria were reexamined by a clinical panel.Results: Forty-six percent of the study population had experienced a mental disorder in their lifetime, and 3.7% had made a suicide attempt. Lifetime prevalence of major depression was 26.5% and 30% for anxiety disorders. Current prevalence rates were 14.2% for anxiety disorders, 10.7% for phobia, 3% for major depression and 1.7% for psychosis.Conclusions: Results show very high rates of lifetime but not current major depression. Rates of current phobia and suicidal ideation in the very elderly are also high compared with other studies. The rates reported are likely to be underestimates.