Anticholinergic medication exposure predicts poor physical capability: Findings from a large prospective cohort study in England.

Kaisa R. Yrjana, Victoria L. Keevil, Roy L Soiza, Robert N. Luben, Nicholas J. Wareham, Kay-Tee Khaw, Phyo K. Myint* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Objectives: To examine whether anticholinergic medication exposure in middle and late life is associated with physical capability.Study design: We used data from 8477 men and women who had enrolled in the European Prospective Investigation of Cancer-Norfolk study at baseline (1HC; 1993–1997) and who had attended its third healthexamination (3HC; 2004–2010). Medication history at the 1HC and 3HC was used to score participants according to the Anticholinergic Cognitive Burden (ACB) Scale at baseline and 3HC; participants were categorised as ACB = 0, ACB = 1, ACB > 2. Main outcome measure: At 3HC, physical capability was objectively measured by: usual walking speed, maximum grip strength, timed chair stands speed (TCSS) and standing balance. Linear and logistic regression modelsexamined prospective and cross-sectional associations between ACB and physical capability, controlling for comorbidity, sociodemographic and lifestyle factors.Results: The analyses included 3386 men and 4110 women who were 56.4 (SD 7.9) and 55.0 (7.7) years old respectively at baseline and 69.4 (8.1) and 67.9 (8.0) years old at follow-up. Significant cross-sectional and prospective relationships were observed for all physical capability measures in women, except grip strength. Forexample, women with ACB ≥ 2 compared with ACB = 0 at baseline had 0.07 m/s (95 % CI -0.11, -0.03) slower usual walking speed, 2.61 stands/min (-4.17, -1.05) slower TCSS and higher odds of being unable to complete atandem stand (odds ratio 2.40, 95 % CI 1.53, 3.76). These trends were observed in men but were less consistent in prospective analyses.Conclusion: Exposure to anticholinergic medication predicts poor physical capability and is a potentially reversible risk factor.
Original languageEnglish
Pages (from-to)55-63
Number of pages9
Early online date25 Jul 2020
Publication statusPublished - 1 Dec 2020

Bibliographical note

The EPIC-Norfolk study has been supported by grants from Medical Research Council [grant numbers G9502233, G0401527] and Cancer
Research UK [grant number C864/A8257]; and the third health examination clinic was supported by a grant from Research into Ageing [grant number 262]. The funders have had no roles in the study design or interpretation of the results. VLK is supported by a MRC/NIHR Clinical Academic Research Partnership Grant. KRY is currently employed as a regulatory affairs student assistant at Lundbeck (Ottiliavej 9, 2500 Copenhagen, Denmark)
We would like to thank the participants of the EPIC-Norfolk study as well as the participating general practitioners and administrative and research staff who made the study possible.


  • Physical capability
  • Anticholinergic burden
  • Older people


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