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Anticholinergic burden of patients with dementia attending a Psychiatry of Later Life service

Published online by Cambridge University Press:  21 May 2019

R. M. Vaughan Open the ORCID record for R. M. Vaughan [Opens in a new window] ,
R. Flynn  and
N. Greene
R. M. Vaughan*
Affiliation:
Psychiatry of Later Life, Tallaght University Hospital, Dublin 24, Ireland
R. Flynn
Affiliation:
Psychiatry of Later Life and School of Medicine, Trinity College Dublin, Dublin, Ireland
N. Greene
Affiliation:
Psychiatry of Later Life, Tallaght University Hospital, Dublin 24, Ireland
*
*Address for correspondence: Dr R. M. Vaughan, Psychiatry of Later Life, Tallaght University Hospital, Dublin 24, Ireland. (Email: roisvaughan@gmail.com)
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Abstract

Objectives

Older adults with dementia are particularly vulnerable to adverse outcomes resulting from anticholinergic use. We aimed to: (i) Examine the anticholinergic burden of patients with dementia attending a Psychiatry of Later Life (PLL) service (ii) Examine concomitant prescription of acetylcholinesterase inhibitors (AChEIs) and anticholinergics and (iii) Compare the Anticholinergic Cognitive Burden (ACB) scale with a recently published composite list of anticholinergics.

Methods

Retrospective chart review of new referrals with a diagnosis of dementia (n = 66) seen by the PLL service, Tallaght University Hospital, Dublin, Ireland, over a consecutive period of 4 months.

Results

The mean ACB score was 2.2 (range = 0–9, SD = 2.1). 37.9% (n = 25) had a clinically significant ACB score (>3) and 42.1% (n = 8) of those taking AChEIs had a clinically significant ACB score. A significantly greater number of medications with anticholinergic activity were identified using the composite list versus the traditional ACB scale (2.3 v.1.5, p = 0.001).

Conclusions

We demonstrated a significant anticholinergic burden amongst patients with dementia attending a specialist PLL service. There was no difference in anticholinergic burden between groups prescribed and not prescribed AChEIs, indicating that these medications are being prescribed without discontinuation of potentially inappropriate medications with anticholinergic activity. The true anticholinergic burden experienced by patients may be underestimated by the use of the ACB score alone, although the clinical significance of this finding is unclear. Calculation of true clinical anticholinergic burden load and its translation to a specific rating scale remains a challenge.

Keywords

Acetylcholinesteraseanticholinergicdementiaolder adults
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 39 , Issue 1 , March 2022 , pp. 39 - 44
Copyright
© The Author(s), 2019. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland

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References

Bottiggi, KA, Salazar, JC, Yu, L, Caban-Holt, AM, Ryan, M, Mendiondo, MS, Schmitt, FA (2006). Long-term cognitive impact of anticholinergic medications in older adults. The American Journal of Geriatric Psychiatry 14, 11.10.1097/01.JGP.0000224619.87681.71CrossRefGoogle ScholarPubMed
Boustani, M, Campbell, N, Munges, S, Maidment, I, Fox, C (2008). Impact of anticholinergics on the aging brain: a review and practical application. Aging Health 4, 311–320.10.2217/1745509X.4.3.311CrossRefGoogle Scholar
Campbell, N, Boustani, M, Limbil, T, Ott, C, Fox, C, Maidment, I, Schubert, CC, Munger, S, Fick, D, Miller, D, Gulati, R (2009). The cognitive impact of anticholinergics: a clinical review. Clinical Interventions in Aging 4, 225.Google ScholarPubMed
Cardwell, K, Hughes, CM, Ryan, C (2015). The association between anticholinergic medication burden and health related outcomes in the ‘oldest old’: a systematic review of the literature. Drugs Aging 32, 835–848.CrossRefGoogle ScholarPubMed
Carnahan, RM, Lund, BC, Perry, PJ, Pollock, BG, Culp, KR (2006). The anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. The Journal of Clinical Pharmacology 40, 1481–1486.CrossRefGoogle Scholar
Cross, AJ, George, J, Woodward, MC, Ames, D, Brodaty, H, Homäki, J, Elliott, RA (2016). Potentially inappropriate medications and anticholinergic burden in older people attending memory clinics in Australia. Drugs & Aging 33, 37–44.CrossRefGoogle ScholarPubMed
Efjestad, AS, Ihle-Hansen, H, Hjellvik, V, Blix, HS (2017). Comedication and treatment length in users of acetylcholinesterase inhibitors. Dementia and Geriatric Cognitive Disorders Extra 7, 30–40.Google Scholar
Fagiolini, A, Comandini, A, Dell’Osso, MC, Kasper, S (2012). Rediscovering trazodone for the treatment of major depressive disorder. CNS Drugs 26, 1033–1049.10.1007/s40263-012-0010-5CrossRefGoogle ScholarPubMed
Fox, C, Richardson, K, Maidment, ID, Savva, GM, Matthews, FE, Smithard, D, Coulton, S, Katona, C, Boustani, MA, Brayne, C (2011). Anticholinergic medication use and cognitive impairment in the older population: The Medical Research Council Cognitive Function and Ageing Study. Journal of the American Geriatrics Society 59, 1477–1483.10.1111/j.1532-5415.2011.03491.xCrossRefGoogle ScholarPubMed
Gill, SS, Mamdani, M, Naglie, G, Streiner, DL, Bronskill, SE, Kopp, A, Shulman, KI, Lee, PE, Rochon, PA (2005). A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Archives of Internal Medicine 165, 808–813.10.1001/archinte.165.7.808CrossRefGoogle ScholarPubMed
Green, AR, Reifler, LM, Boyd, CM, Weffald, LA, Bayliss, EA (2018). Medication profiles of patients with cognitive impairment and high anticholinergic burden. Drugs & Aging 5, 1–10.Google Scholar
Hilmer, SN, Mager, DE, Simonsick, EM, Cao, Y, Ling, SM, Windham, BG, Harris, TB, Hanlon, JT, Rubin, SM, Shorr, RI, Bauer, DC, Abernethy, DR (2007). A drug burden index to define the functional burden of medications in older people. Archives of Internal Medicine 167, 781–787.10.1001/archinte.167.8.781CrossRefGoogle ScholarPubMed
Jaïdi, Y, Nonnonhou, V, Kanagaratnam, L, Bertholon, LA, Badr, S, Noël, V, Mahmoudi, R (2018). Reduction of the anticholinergic burden makes it possible to decrease behavioral and psychological symptoms of dementia. The American Journal of Geriatric Psychiatry 23, 280–288.10.1016/j.jagp.2017.08.005CrossRefGoogle Scholar
Johnell, K, Fastbom, J (2008). Concurrent use of anticholinergic drugs and cholinesterase inhibitors. Drugs & Aging 25, 871–877.10.2165/00002512-200825100-00006CrossRefGoogle ScholarPubMed
Koyama, A, Steinman, M, Ensrud, K, Hillier, TA, Yaffe, K (2014). Long-term cognitive and functional effects of potentially inappropriate medications in older women. Journal of Gerontology: Biological Sciences & Medical Sciences 69, 423–429.Google ScholarPubMed
Lu, CJ, Tune, LE (2003). Chronic exposure to anticholinergic medications adversely affects the course of Alzheimer disease. American Journal of Geriatric Psychiatry 11, 458–461.CrossRefGoogle ScholarPubMed
Mate, KE, Kerr, KP, Pond, D, Williams, EJ, Marley, J, Disler, P, Brodaty, H, Magin, PJ (2015). Impact of multiple low-level anticholinergic medications on anticholinergic load of community-dwelling elderly with and without dementia. Drugs Aging 32, 159–167.10.1007/s40266-014-0230-0CrossRefGoogle ScholarPubMed
Moore, AR, O’Keefe, ST (1999). Drug-induced cognitive impairment in the elderly. Drugs and Aging 15, 15–2810.2165/00002512-199915010-00002CrossRefGoogle ScholarPubMed
Moriarty, F, Bennett, K, Cahir, C, Kenny, RA, Fahey, T (2016). Potentially inappropriate prescribing according to STOPP and START and adverse outcomes in community-dwelling older people: a prospective cohort study. British Journal of Clinical Pharmacology, 82, 849–857.CrossRefGoogle ScholarPubMed
Reppas-Rindlisbacher, CE, Fischer, HD, Fung, K, Gill, SS, Seitz, D, Tannenbaum, C, Austin, PC, Rochon, PA (2016). Anticholinergic drug burden in persons with dementia taking a cholinesterase inhibitor: the effect of multiple physicians. Journal of the American Geriatrics Society 64, 492–500.CrossRefGoogle ScholarPubMed
Richardson, K, Fox, C, Maidment, I, Steel, N, Loke, YK, Arthur, A, Myint, PK, Grossi, CM, Mattishent, K, Bennett, K, Campbell, NL (2018). Anticholinergic drugs and risk of dementia: case-control study. British Medical Journal, 361, k1315.10.1136/bmj.k1315CrossRefGoogle ScholarPubMed
Roe, CM, Anderson, MJ, Spivack, B (2002). Use of anticholinergic medications by older adults with dementia. Journal of the American Geriatrics Society 50, 836–842.CrossRefGoogle ScholarPubMed
Rudolph, JL, Salow, MJ, Angelini, MC, McGlinchey, RE (2008). The anticholinergic risk scale and anticholinergic adverse effects in older persons. Archives of Internal Medicine 168, 508–513.CrossRefGoogle ScholarPubMed
Salahudeen, MS, Duffull, SB, Nishtala, PS (2015a). Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatrics 15, 31.10.1186/s12877-015-0029-9CrossRefGoogle ScholarPubMed
Salahudeen, MS, Hilmer, SN, Nishtala, PS (2015b). Comparison of anticholinergic risk scales and associations with adverse health outcomes in older people. Journal of the American Geriatrics Society 63, 85–90.10.1111/jgs.13206CrossRefGoogle ScholarPubMed
Schultz, BR, Takeshita, J, Goebert, D, Takeshita, S, Lu, BY, Guilloux, A, Higa, J (2017). Simultaneous usage of dementia medications and anticholinergics among Asians and Pacific Islanders. Psychogeriatrics 17, 423–429.CrossRefGoogle ScholarPubMed
Sink, KM, Thomas, J, Xu, H, Craig, B, Kritchevsky, S, Sands, LP (2008). Dual use of bladder anticholinergics and cholinesterase inhibitors: long term functional and cognitive outcomes. Journal of the American Geriatrics Society 56, 847–853.CrossRefGoogle ScholarPubMed
Sittironnarit, G, Ames, D, Bush, AI, Faux, N, Flicker, L, Foster, J, Hilmer, S, Lautenschlager, NT, Maruff, P, Masters, CL, Martins, RN, Rowe, C, Szoeke, C, Ellis, KA (2011). Effects of anticholinergic drugs on cognitive function in older Australians: results from AIBL study. Dementia and Geriatric Cognitive Disorders 21, 173–178.10.1159/000325171CrossRefGoogle Scholar
Tune, LE, Egeli, S (1999). Acetylcholine and delirium. Dementia and Geriatric Cognitive Disorders 10, 342–344.CrossRefGoogle ScholarPubMed
Watanabe, S, Fukatsu, T, Kanemoto, K (2018). Risk of hospitalization associated with anticholinergic medication for patients with dementia. Psychogeriatrics 18, 57–63.10.1111/psyg.12291CrossRefGoogle ScholarPubMed