(P23-024-23) The Drug Burden Index Is Associated With Measures of Cognitive Function Among Older Adults in the Health, Aging, and Body Composition Study

Objectives: Many conditions associated with aging result in polypharmacy, and anticholinergic and sedative medications may impact cognition among older adults. One way to assess exposure to such medications is the Drug Burden Index (DBI). The DBI is a validated measure of exposure to anticholinergic and sedative medications, with a higher DBI score indicating a higher drug burden. The objective of this ancillary longitudinal analysis was to investigate the association between DBI and cognitive function assessed by the Modified Mini-Mental State Test (3MS) and the Digit Symbol Substitution Test (DSST).

Methods: The Health, Aging, and Body Composition Study was a prospective study of community-dwelling adults ages 70-79 years at enrollment. Using data from years 1, 5, and 10, DBI per medication was calculated by dividing the daily dose of each medication by the sum of the daily dose and the minimum efficacious dose as approved by the Food and Drug Administration. The sum of each DBI per medication was taken to reflect total DBI scores per participant. Longitudinal linear mixed modeling was used to assess the effect of DBI on 3MS and DSST separately. Adjusted models included the covariates of biological sex, race, education level, and APOE status.

Results: 3MS scores were not significantly associated with DBI in the unadjusted model (ß(SE)= -0.28(0.21); 95% CI -0.68, 0.13; p=0.179) but were in the adjusted model (ß(SE)= -0.60(0.28); 95% CI -1.15, -0.04; p=0.034). In both unadjusted and adjusted models, DSST scores were significantly inversely associated with DBI (ß(SE)= -0.89(0.29); 95% CI -1.47, 0.32; p=0.002 and ß(SE)= -2.02 (0.48); 95% CI -2.96, -1.09); p< 0.001, respectively).

Conclusions: Results suggest that DBI is associated with a decline in objective measures of cognitive performance in high-functioning older adults. Thus, the DBI represents a useful pharmacological tool for assessing the effect of medication exposure on cognition.

Funding Sources: The authors have no funding sources to disclose for this research.