Impact of anticholinergic burden on cognitive performance: a cohort study of community-dwelling older adults

Older people are susceptible to the adverse effects of anticholinergic medications, including cognitive impairment. 1 A systematic review of observational studies reported mixed associations between high anticholinergic burden, a cumulative measure of anticholinergic medications, and cognitive performance in older people. 2 Observational studies may have biased estimates of the impact of exposures, as the exposed and unexposed may systematically differ in covariates associated with the outcomes. 3 The inverse probability of treatment weight (IPTW) is a causal method used to adjust exposure effect and mitigate confounding by eliminating the strong influence of imbalanced covariates on the exposure. 4 In this context, we examined the association between anticholinergic burden and cognitive function in a nationwide community-dwelling older adult sample using the IPTW method for confounding control.