by Justin Jackson, Phys.org
Kaiser Permanente Washington scientists report that higher cumulative anticholinergic exposure predicted a faster decline in gait speed and grip strength among older adults.
Older adults frequently receive prescriptions for anticholinergic medications that interfere with acetylcholine, a neurotransmitter essential for memory and muscle activation, leading to cognitive fog, confusion, and falls. Prescribing patterns are slowly shifting in response to warnings about these declines, but long-term use is still common.
Previous studies have reported possible associations between anticholinergic use and slower gait speed or weaker grip strength with a pooled effect that appears small and not clinically meaningful.
In the study, “Cumulative Anticholinergic Exposure and Change in Gait Speed and Grip Strength in Older Adults,” published in JAMA Network Open, researchers used a cohort study design to assess whether cumulative anticholinergic exposure has any associated effect on annual rates of decline in gait speed and grip strength.
A total of 4,283 participants enrolled in the Adult Changes in Thought study at Kaiser Permanente Washington between 1994 and 2020. Eligibility required at least 10 years of continuous health plan enrollment and a minimum of two study visits with gait speed or grip strength measurements. The mean ages were 74.3–74.5 years and 58.5–58.6% of the participants were women, across outcome samples.
Anticholinergic exposure was estimated through pharmacy dispensing records and quantified as total standardized daily dose over 10 years and mean standardized daily dose over two years.
Weighted cumulative exposure models allowed two, four, six, eight, or 10-year assessment windows to account for time-varying effects. Gait speed and grip strength were assessed during biennial visits by standardized protocols.
Four-year weighted cumulative exposure provided the best statistical fit among models tested and indicated a decline of -0.0034 m/s per year per 1-unit increase in weighted mean standardized daily dose.
No significant associations appeared between conventional exposure measures and grip strength. Six-year weighted cumulative exposure did show a significant decline in grip strength (-0.0329 kg per year per 1-unit increase in weighted mean standardized daily dose).
Researchers conclude that higher cumulative anticholinergic use was associated with greater decline rates of gait speed and grip strength beyond aging and comorbidities.
Authors warn that accumulation of small losses can become clinically meaningful over time and recommend that clinicians avoid anticholinergics when possible, prescribe the lowest effective dose, and periodically reevaluate patients to identify deprescribing opportunities.
Written for you by our author Justin Jackson, edited by Sadie Harley, and fact-checked and reviewed by Andrew Zinin—this article is the result of careful human work. We rely on readers like you to keep independent science journalism alive. If this reporting matters to you, please consider a donation (especially monthly). You’ll get an ad-free account as a thank-you.
More information: Shelly L. Gray et al, Cumulative Anticholinergic Exposure and Change in Gait Speed and Grip Strength in Older Adults, JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2025.
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