Anticholinergic and sedative medications are associated with neurocognitive performance of well treated people with human immunodeficiency virus. Open Forum Infectious Diseases
Jakeman et al. for the NAMACO Study Group aimed to further evaluate the effect of anticholinergic (ACH) and sedative medications on neurocognitive functions in the Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study group who underwent comprehensive neuropsychological (NP) evaluation using a standardized assessment battery as part of the NAMACO study.
Neurocognitive functions were analyzed in 5 domains (motor skills, speed of information, attention/working memory, executive functions, and verbal learning memory).
A total of 963 people with HIV (PWH) (80% male, 92% Caucasian, 96% virologically suppressed, median age 52) were included. Fourteen percent of participants were prescribed ≥1 ACH medication and 9% were prescribed ≥1 sedative medication. Overall, 40% of participants had neurocognitive impairment (NCI). Sedative medication use was associated with impaired attention/verbal learning and ACH medication use with motor skills deficits both in the continuous (mean z-score difference −0.26 to −0.14, P<.001 and P=.06) and binary (odds ratio [OR], ≥1.67; P<.05) models. Their combined use was associated with deficits in overall neurocognitive functions in both models (mean z-score difference −0.12, P=.002 and OR = 1.54, P=.03). These associations were unchanged in a subgroup analysis of participants without depression (n=824).
In conclusion, this study shows that medications with ACH and/or sedative properties contribute to NCI in well treated PWH. Therefore, HIV clinicians need to consider non-HIV medications when evaluating NCI. Anticholinergic and sedative medications are used more often in females, which may explain the higher prevalence of NCI in females compared to males, although this observation could also relate to sociodemographic differences. In future studies, researchers will need to evaluate the impact of discontinuing or substituting ACH and sedative medications on neurocognitive performance particularly in well treated PWH.