Long‐term anticholinergic, benzodiazepine and Z‐drug use in community‐dwelling older adults: What is the impact on cognitive and neuropsychological performance?

Adam H. Dyer, Eamon Laird, Leane Hoey, Catherine F. Hughes, Helene McNulty, Mary Ward, J. J. Strain, Anne M. Molloy, Conal Cunningham, Kevin McCarroll

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Background: Long-term use of anticholinergics, benzodiazepines and related drugs (or “Z-drugs”) have been associated with cognitive impairment and dementia. However, the relationship of these medications with cognitive function and domain-specific neuropsychological performance in older adults without dementia, is unclear. Methods: 5135 older adults (74.0 ± 8.3 years; 67.4% female) without a diagnosis of dementia were recruited in Ireland to the Trinity-Ulster-Department of Agriculture (TUDA) study. Detailed cognitive and neuropsychological assessment was conducted using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Results: A total of 44% (2259 of 5153) used either a potential or definite anticholinergic medication. Overall, 9.7% (n = 500) used a definite anticholinergic medication. Regular benzodiazepine use was reported by 7% (n = 363), whilst 7.5% (n = 387) used a “Z-drug”. Use of definite, but not potential anticholinergic medication was associated with poorer performance on all three assessments (β: −0.09; 95% CI: −0.14, −0.03, p = 0.002 for MMSE; β: −0.04; 95% CI: −0.06, −0.02; p < 0.001 for FAB; β: −4.15; 95% CI: −5.64, −2.66; p < 0.001 for RBANS) in addition to all domains of the RBANS. Regular benzodiazepine use was also associated with poorer neuropsychological test performance, especially in Immediate Memory (β: −4.98; 95% CI: −6.81, −3.15; p < 0.001) and Attention (β: −6.81; 95% CI: −8.60, −5.03; p < 0.001) RBANS domains. Conclusions: Regular use of definite anticholinergic medications and benzodiazepines, but not potential anticholinergics or “Z-drugs”, was associated with poorer overall and domain-specific neuropsychological performance in older adults.

Original languageEnglish
Pages (from-to)1767-1777
Number of pages11
JournalInternational Journal of Geriatric Psychiatry
Issue number11
Early online date6 Jul 2021
Publication statusPublished online - 6 Jul 2021

Bibliographical note

Funding Information:
The authors wish to acknowledge the Irish Department of Agriculture, Food and the Marine and Health Research Board (under the Food Institutional Research Measure, FIRM, initiative) and from the Northern Ireland Department for Employment and Learning (under its Strengthening the All-Island Research base initiative), in addition to all TUDA study participants.

Publisher Copyright:
© 2021 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.


  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • cognition
  • anticholinergic medication
  • older adults
  • benzodiazepine


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