Objective: To determine the cognitive consequences of anticholinergic medications (aCH) in cognitively normal older adults as well as interactive effects of genetic and cerebrospinal fluid (CSF) Alzheimer’s disease (AD) risk factors. Methods: 688 cognitively normal participants from the Alzheimer’s Disease Neuroimaging Initiative were evaluated (mean age = 73.5, 49.6% female). Cox regression examined risk of progression to mild cognitive impairment (MCI) over a 10-year period, and linear mixed effects models examined 3-year rates of decline in memory, executive function, and language as a function of aCH. Interactions with APOE 4 genotype and CSF biomarker evidence of AD pathology were also assessed. Results: aCH+ participants had increased risk of progression to MCI (HR = 1.42, p = .02), and there was a significant aCH x AD-risk interaction such that (aCH+)(&[epsilon]4+) individuals showed greater than 2-fold increased risk (HR = 2.47, p < .001) for incident MCI relative to (aCH-)(&[epsilon]4-), while (aCH+)(p-tau/Aß+) individuals demonstrated greater than 4-fold (HR = 4.25, p < .001) increased risk relative to (aCH-)(p-tau/Aß-). Linear mixed effects models revealed that aCH predicted a steeper slope of decline in memory (t = -2.31, p = .02) and language (t = -2.35, p = .02), with effects exacerbated in individuals with AD risk factors. Conclusions: aCH increased risk of incident MCI and cognitive decline, and effects were significantly enhanced among individuals with genetic risk factors and CSF-based AD pathophysiological markers. Findings underscore the adverse impact of aCH medications on cognition and the need for deprescribing trials, particularly among individuals with elevated risk for AD.

The uploaded data comprise several appendices that include sensitivity analyses for the manuscript "Anticholinergic medications: A potentially modifiable risk factor for development of MCI" by Weigand et al. Methods details for these data can be found in the manuscript text.