In people with a high Anticholinergic Cognitive Burden (ACB), PLWH did worse on learning and executive function tests than HIV-negative controls, researchers reported in AIDS.
The brain’s cholinergic system is involved in attention and higher-order cognitive processing, and its disruption may be involved in Alzheimer’s disease. More than 600 medications, including treatments for asthma, Parkinson’s disease, depression, allergies, and other symptoms, have some anticholinergic properties.
Study authors analyzed neuropsychological testing and neuroimaging data on 209 PLWH and 95 HIV-negative controls. Overall, PWLH used more anticholinergic medications than HIV-negative people, and their associated burden was higher. However, HIV-negative participants were younger on average, and poorly matched on sex, depressive symptoms, and tobacco and marijuana use. The total proportion of PLWH with a high ACB was also relatively low (16%), though it was higher than for HIV-negative participants (10.5%).
Over time, a decrease in ACB among PLWH was associated with improved executive function, retention, and global cognition. No such change was observed in HIV-negative controls.
While brain volumes declined among participants with high ACB independent of serostatus, the pattern differed, with results for PLWH similar to those observed in prior studies on aging and Alzheimer’s disease, according to the study authors.
The researchers noted that drug interactions with other prescription medications or antiretroviral therapy was not assessed. They recommended careful monitoring of anticholinergic medications among older PLWH, and deprescription of such drugs when possible.