Aging
Antidepressant and Anti-Anxiety Medication Use and Longitudinal Cognitive Function in Older Adults Maria Springall De Pablo* Maria Springall De Pablo Springall De Pablo Springall De Pablo Springall De Pablo Springall De Pablo The University of Chicago
Antidepressant and anti-anxiety (anxiolytic) use has increased. For older adults, there have been concerns about side effects including cognitive decline, especially for benzodiazepines. We examined medication use and cognitive function over time in a national cohort of older adults (National Social Life, Health and Aging Project), overall and by drug class based on known mechanism of action (MOA).
4,100 older adults (born 1927-65) were interviewed up to 3 times at home every ~5 years (2010/1, 2015/6, 2021/3). Interviewers recorded medications by label into a database. Cognitive function was measured using the Montreal Cognitive Assessment Survey Adaptation (MOCA-SA, score 0-20). Multivariable linear mixed models simultaneously examined associations between antidepressant and anxiolytic counts (0, 1, >1) and MOCA-SA, adjusting for age, gender, race/ethnicity, education, depression and anxiety symptoms, and tobacco and alcohol use. Gender effect modification was assessed. MOA models used these categories: anticholinergic antidepressants, benzodiazepines, other antidepressants, and other anxiolytics.
Use of 1 antidepressant was associated with a 0.28 decrease in MOCA-SA scores (95% CI: -0.46, -0.11), and >1 was associated with a 0.45 decrease (95% CI: -0.80, -0.09). The association was stronger among men (-0.52, 95% CI: -0.79, -0.24) than women (-0.20, 95% CI: -0.40, 0.01), but the interaction term was not significant. Anxiolytics were not significantly associated with MOCA-SA. MOA models showed lower scores for anticholinergic antidepressant users (-0.53, 95% CI: -0.88, -0.18) and other antidepressant users (-0.23, 95% CI: -0.40, -0.05), but not for benzodiazepines or other anxiolytics.
Across time, antidepressant use is associated with lower cognitive scores. This association is stronger with >1 antidepressant, among men, and among anticholinergic antidepressant users. Anxiolytics, including benzodiazepines, showed no significant association with cognitive function.