Journal
SCHIZOPHRENIA BULLETIN
Volume 47, Issue 1, Pages 259-267Publisher
OXFORD UNIV PRESS
DOI: 10.1093/schbul/sbaa094
Keywords
aging; anticholinergic burden; cognition; functional capacity; schizophrenia
Categories
Funding
- MATRICS initiative through the National Institute of Mental Health at the National Institutes of Health [N01MH22006]
- Canadian Institutes of Health Research [CIHR 200017, CIHR180087]
- Centre for Addiction and Mental Health (CAMH)
- MRC [MR/S037675/1] Funding Source: UKRI
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The study found that individuals with schizophrenia are commonly exposed to severe anticholinergic burden (ACB), which can have a direct negative impact on functional capacity after controlling for its impact on cognition. ACB, age, education, and cognition were independent predictors of functional capacity, with ACB predicting cognition in those aged 55 years and older. Cognition partially mediated the effect of ACB on functional capacity in this older cohort.
Anticholinergic burden (ACB) from medications impairs cognition in schizophrenia. Cognition is a predictor of functional capacity; however, little is known about ACB effect on functional capacity in this population. This study assesses the relationship between ACB and functional capacity across the life span in individuals with schizophrenia after controlling for ACB effect on cognition. A cross-sectional analysis was performed with data collected from 6 academic tertiary health centers. Two hundred and twenty-three community-dwelling participants with schizophrenia or schizoaffective disorder were included in this study. Main variables were ACB, antipsychotic olanzapine equivalents, functional capacity, cognition, and negative symptoms. Simultaneous linear regression analyses were performed to assess the association between ACB, functional capacity, and cognition and then between ACB and cognition. A mediation analysis was then performed to examine whether cognition mediated ACB effect on functional capacity if there was an association between ACB and cognition. Mean age of participants was 49.0 years (SD = 13.1, range 19-79), and 63.7% of participants had severe ACB, ie, a total score of 3 or above. Regression analyses revealed that ACB, age, education, and cognition independently predicted functional capacity and that ACB predicted cognition among those aged 55 years and older. Mediation analysis showed that cognition did partially mediate the effect of ACB on functional capacity in this older cohort. In conclusion, people with schizophrenia are exposed to severe ACB that can have a direct negative impact on functional capacity after controlling for its impact on cognition. Reducing ACB could improve functional capacity and potentially real-world function in schizophrenia.
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