Background: Anticholinergic and sedative medications are frequently prescribed to older individuals. These medications are associated with short-term cognitive and physical impairment, but less is... Show moreBackground: Anticholinergic and sedative medications are frequently prescribed to older individuals. These medications are associated with short-term cognitive and physical impairment, but less is known about long-term associations. We therefore examined whether over 20 years cumulative exposure to these medications was related to poorer cognitive and physical functioning.Methods: Older adult participants of the Longitudinal Aging Study Amsterdam (LASA) were followed from 1992 to 2012. On seven measurement occasions, cumulative exposure to anticholinergic and sedative medications was quantified with the drug burden index (DBI), a linear additive pharmacological dose-response model. Cognitive functioning was assessed with the Mini-Mental State Examination (MMSE), Alphabet Coding Task (ACT, three trials), Auditory Verbal Learning Test (AVLT, learning and retention condition), and Raven Colored Progressive Matrices (RCPM, two trials). Physical functioning was assessed with the Walking Test (WT), Cardigan Test (CT), Chair Stands Test (CST), Balance Test (BT), and self-reported Functional Independence (FI). Data were analyzed with linear mixed models adjusted for age, education, sex, living with a partner, BMI, depressive symptoms, comorbidities (cardiovascular disease, diabetes, cancer, COPD, osteoarthritis, CNS diseases), and prescribed medications.Results: Longitudinal associations were found of the DBI with poorer cognitive functioning (less items correct on the three ACT trials, AVLT learning condition, and the two RCPM trials) and with poorer physical functioning (longer completion time on the CT, CST, and lower self-reported FI).Conclusions: This longitudinal analysis of data collected over 20 years, showed that higher long-term cumulative exposure to anticholinergic and sedative medications was associated with poorer cognitive and physical functioning. Show less
Zuiker, R.G.J.A.; Chen, X.; Osterberg, O.; Mirza, N.R.; Muglia, P.; Kam, M. de; ... ; Gerven, J.M.A. van 2016
This thesis describes the development and initial validation of the Benzodiazepine Craving Questionnaire (BCQ), a Rasch-homogeneous self-report questionnaire to assess craving for benzodiazepines.... Show moreThis thesis describes the development and initial validation of the Benzodiazepine Craving Questionnaire (BCQ), a Rasch-homogeneous self-report questionnaire to assess craving for benzodiazepines. This questionnaire was developed as part of the Benzoredux project, which was designed to evaluate a stepped-care approach to reduce long-term benzodiazepine use in general practice. In chapter 1 aspects of (long-term) benzodiazepine use are discussed (definition; prevalence; dependence). We address the role of craving in dependence on addictive substances and find that benzodiazepine craving research is scarce. Chapter 2 describes the development and initial validation of the BCQ. Chapter 3 describes characteristics of patients reporting benzodiazepine craving and associations between benzodiazepine craving and other clinical variables in a general practice population who had made an attempt to discontinue their long-term benzodiazepine use. In chapter 4 we have aimed to assess benzodiazepine craving longitudinally and have described its course by means of the BCQ. Chapter 5 addresses the scope of the craving definition (broad versus narrow). In Chapter 6 we find that in long-term benzodiazepine users who received a supervised tapering off protocol after a failed attempt to quit on their own, benzodiazepine craving predicts relapse during a 15-month follow-up period independent of other predictors. Chapter 7 presents a general discussion. Show less
