Anticholinergic and Sedative Medications Are Associated With Neurocognitive Performance of Well Treated People With Human Immunodeficiency Virus
Authors: Jakeman Bernadette , Scherrer Alexandra U , Darling Katharine E A , Damas Jose , Bieler-Aeschlimann Melanie , Hasse Barbara , Schlosser Ladina , Hachfeld Anna , Gutbrod Klemens , Tarr Philip E , Calmy Alexandra , Assal Frederic , Kunze Ursula , Stoeckle Marcel , Schmid Patrick , Toller Gianina , Rossi Stefania , di Benedetto Caroline , du Pasquier Renaud , Cavassini Matthias , Marzolini Catia ,   NAMACO Study Group, a Swiss HIV Cohort Study, Cavassini Matthias , Du Pasquier Renaud , Bieler-Aeschlimann Melanie , Nadin Isaure , Brugger Peter , Gutbrod Klemens , Monsch Andreas U , Kunze Ursi , Toller Gianina , Schlosser Ladina , Schwind Marc , Rossi Stefania , Sokolov Arseny , Assal Frederic , Derfuss Tobias , von Arx Sebastian , Eisele Gunter , Bertschi Manuel , Hundsberger Thomas , Oberholzer Michael , Jelcic Illijas , Sacco Leonardo , Du Pasquier Renaud , Calmy Alexandra , Lecompte Thanh Doco , Hachfeld Anna , Kovari Helen , Hasse Barbara , Tarr Philip , Stoeckle Marcel , Fux Christoph , Bernasconi Enos , Benedetto Caroline Di , Schmid Patrick , Darling Katharina , Cavassini Matthias , Scherrer Alexandra , Kusejko Katharina , Vallet Yannick , Sormani Valerie , Damas Jose , Ledergerber Bruno , Locatelli Isabella , Marzolini Catia , Decosterd Laurent , Granziera Cristina , Krueger Gunnar , Meuli Reto , Vargas Maria 
Published: September 2022

Abstract

Background
We previously showed that anticholinergic (ACH) medications contribute to self-reported neurocognitive impairment (NCI) in elderly people with human immunodeficiency virus (PWH). The current cross-sectional study further evaluated the effect of ACH and sedative drugs on neurocognitive function in PWH who underwent comprehensive neuropsychological evaluation.

Methods
A medication review was performed in PWH enrolled in the prospective Neurocognitive Assessment in Metabolic and Aging Cohort within the Swiss HIV Cohort Study. Neurocognitive functions were analyzed in 5 domains (motor skills, speed of information, attention/working memory, executive functions, and verbal learning memory). The effect of ACH and sedative medications on neurocognitive functioning was evaluated using linear regression models for the continuous (mean z-score) outcome and multivariable logistic regression models for the binary (presence/absence) outcome.

Results
A total of 963 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 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 &lt; .001 and P = .06) and binary (odds ratio [OR], ≥1.67; P &lt; .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).

Conclusions
Anticholinergic and sedative medications contribute to NCI. Clinicians need to consider these drugs when assessing NCI in PWH.