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Peer-reviewedCC BY 4.0European Psychiatry

Cognitive performance in older-age bipolar disorder: A cross-sectional study of anticholinergic load and clinical characteristics

  • Simone Pardossi1,2,3
  • Brisa Solé3
  • Andrea Ruiz2,3,4
  • Marta Bort2,3,4
  • Arturo Rodríguez-Rey2,3,4
  • Ainara Espluga2,3,4
  • Meritxell González-Campos2,3,4
  • Marc Valentí2,3,4
  • Giovanna Fico2,3,4
  • Andrea Murru2,3,4,5
  • Jose Sanchez-Moreno2,3,4,6
  • Anabel Martinez-Aran2,3,4,6
4 more authors
  • Andrea Fagiolini1
  • Eduard Vieta2,3,4,6
  • Michele De Prisco2,3,4,6
  • Laura Montejo2,3,4,6
6 affiliations
  1. 1Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy
  2. 2Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
  3. 3Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
  4. 4Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona (UBNeuro), Barcelona, Spain
  5. 5Sleep Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain
  6. 6Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Abstract

Background: Cognitive deficits are one of the core features of older-age bipolar disorder (OABD). Psychotropic medications may influence cognition, especially in older populations, where anticholinergic effects are relevant. This cross-sectional study aimed to investigate the potential impact of anticholinergic load on cognitive performance in individuals with OABD.

Methods: One hundred and twenty-one euthymic or partially remitted OABD patients were included. Cognitive performance was assessed using a neuropsychological battery and summarized into attention, processing speed, working memory, visual and verbal memory, and executive functions. Anticholinergic load was assessed using the CRIDECO Anticholinergic Load Scale (CALS), and pharmacological burden was quantified using the defined daily dose (DDD). Associations were examined using hierarchical multivariable linear regression models, considering also relevant clinical covariates.

Results: The interaction between CALS and DDD was associated with lower visual and verbal memory scores (p = 0.04). Age was inversely associated with cognitive performance across all domains (all p < 0.01). A higher number of manic episodes was associated with poorer attention, visual and verbal memory, and processing speed (all p < 0.01). Lifetime psychotic symptoms were associated with worse working memory (p = 0.02), and higher diazepam-equivalent doses were associated with worse visual and verbal memory performance (p = 0.02).

Conclusions: Although anticholinergic medications may contribute to cognitive burden, their impact appears dose-related and limited compared with the broader influence of illness-related factors. In OABD patients, prioritizing the management of illness-related characteristics alongside careful pharmacological management may therefore be crucial for preserving cognitive functioning.

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Cite

BibTeXRIS
BibTeX
@article{pardossi2026cognitive,
  title = {{Cognitive performance in older-age bipolar disorder: A cross-sectional study of anticholinergic load and clinical characteristics}},
  author = {Simone Pardossi and Brisa Solé and Andrea Ruiz and Marta Bort and Arturo Rodríguez-Rey and Ainara Espluga and Meritxell González-Campos and Marc Valentí and Giovanna Fico and Andrea Murru and Jose Sanchez-Moreno and Anabel Martinez-Aran and Andrea Fagiolini and Eduard Vieta and Michele De Prisco and Laura Montejo},
  journal = {European Psychiatry},
  year = {2026},
  month = jul,
  doi = {10.1192/j.eurpsy.2026.12247},
  url = {https://doi.org/10.1192/j.eurpsy.2026.12247},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Cognitive performance in older-age bipolar disorder: A cross-sectional study of anticholinergic load and clinical characteristics
AU  - Simone Pardossi
AU  - Brisa Solé
AU  - Andrea Ruiz
AU  - Marta Bort
AU  - Arturo Rodríguez-Rey
AU  - Ainara Espluga
AU  - Meritxell González-Campos
AU  - Marc Valentí
AU  - Giovanna Fico
AU  - Andrea Murru
AU  - Jose Sanchez-Moreno
AU  - Anabel Martinez-Aran
AU  - Andrea Fagiolini
AU  - Eduard Vieta
AU  - Michele De Prisco
AU  - Laura Montejo
PY  - 2026
DA  - 2026/07/31
JO  - European Psychiatry
DO  - 10.1192/j.eurpsy.2026.12247
UR  - https://doi.org/10.1192/j.eurpsy.2026.12247
AB  - Background: Cognitive deficits are one of the core features of older-age bipolar disorder (OABD). Psychotropic medications may influence cognition, especially in older populations, where anticholinergic effects are relevant. This cross-sectional study aimed to investigate the potential impact of anticholinergic load on cognitive performance in individuals with OABD.  Methods: One hundred and twenty-one euthymic or partially remitted OABD patients were included. Cognitive performance was assessed using a neuropsychological battery and summarized into attention, processing speed, working memory, visual and verbal memory, and executive functions. Anticholinergic load was assessed using the CRIDECO Anticholinergic Load Scale (CALS), and pharmacological burden was quantified using the defined daily dose (DDD). Associations were examined using hierarchical multivariable linear regression models, considering also relevant clinical covariates.  Results: The interaction between CALS and DDD was associated with lower visual and verbal memory scores (p = 0.04). Age was inversely associated with cognitive performance across all domains (all p < 0.01). A higher number of manic episodes was associated with poorer attention, visual and verbal memory, and processing speed (all p < 0.01). Lifetime psychotic symptoms were associated with worse working memory (p = 0.02), and higher diazepam-equivalent doses were associated with worse visual and verbal memory performance (p = 0.02).  Conclusions: Although anticholinergic medications may contribute to cognitive burden, their impact appears dose-related and limited compared with the broader influence of illness-related factors. In OABD patients, prioritizing the management of illness-related characteristics alongside careful pharmacological management may therefore be crucial for preserving cognitive functioning.
SN  - 0924-9338
SN  - 1778-3585
ER  -