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Abstract
The present study is the first to examine the links among anticholinergic drug burden, neurocognition, and community functioning in outpatients with serious mental illness (SMI). Although drugs with anticholinergic properties are understood to have deleterious effects on cognition, relatively little is known of their long-term consequences, particularly with respect to treatment outcome and higher-order processes such as social behavior. This is of particular import to people with SMI, who are commonly prescribed multiple drugs with anticholinergic properties.
Method. This project utilized longitudinal archival data from 88 outpatients with SMI. The aim was to determine the following: (a) whether anticholinergic burden predicts treatment outcome, as measured by trajectories of community functioning; (b) whether some people are more vulnerable to adverse anticholinergic effects than others; and (c) whether anticholinergic burden has an effect on community functioning independent of neurocognition.
Results. There was mixed support for the hypotheses. Community functioning increased, on average, over the course of treatment; however, the overall linear trajectory was higher or lower depending on levels of anticholinergic burden. Participants with greater anticholinergic burden had lower levels of community functioning, even when controlling for illness severity.
Contrary to one of the hypotheses, anticholinergic burden was not associated with any measure of neurocognition. Neurocognition did not predict levels of overall community functioning; however, associations were found between neurocognition and specific domains of community functioning. Finally, medical burden and neuropathology were identified as significant moderators of the association between anticholinergic burden and community functioning. However, the pattern of the interactions suggested that medical conditions masked, rather than exacerbated, the negative effects of anticholinergic burden.
Conclusions. This project extends the relatively sparse literature on anticholinergic burden and real-world functioning to SMI populations and psychiatric rehabilitation outcomes. The findings suggest that anticholinergic burden may impact community functioning independent of neurocognition.
