A Novel Scale Linking Potency and Dosage to Estimate Anticholinergic Exposure in Older Adults: the Muscarinic Acetylcholinergic Receptor ANTagonist Exposure Scale

Abstract

Quantification of the anticholinergic exposure insufficiently or imprecisely incorporates dosage information, leading to inaccurate estimations. The aim was to construct a novel scale, including potency and dosage for the quantification of the anticholinergic exposure in older adults. Potency information was retrieved from a previous systematic review. The dosage range for each drug was delineated in minimal, maintenance and maximal dosage for adults and older adults. Dosage information was collected from authoritative sources and reviewed in an expert panel. The Muscarinic Acetylcholinergic Receptor ANTagonist Exposure (MARANTE) scale was tested for clinimetric properties using cohorts of community-dwelling older adults and nursing home residents. After three data collection rounds, data for the dosage ranges remained incomplete for 32 active substances. Remaining gaps were filled in, and 11 dosage adjustments were proposed during the expert panel meeting. We chose the values {0; 1; 2) for the categories of potency and {0; 0.5; 1; 1.5; 2) for the levels of dosage ranges, showing good clinimetric properties. Forty-one anticholinergic drugs were prescribed in the two cohorts. Most (61%) were low potency anticholinergics and used for depression (19%, e.g. citalopram). There were 31.8% (median MARANTE 1.5, IQR 1.5-2.5) and 37.6% (median 2, IQR 1.5-2.5) anticholinergic users in the community-dwelling cohort and nursing home cohort, respectively. The MARANTE scale combines potency with the dosage spectrum, to quantify the anticholinergic exposure in older adults. An open feedback system on the list of anticholinergic and proposed anticholinergic potency and dosage values is advised.

Anticholinergic and sedative medication use in older community‐dwelling people: A national population study in the Netherlands

“… This is why we quantified the combined load of anticholinergic and sedative medications. Other tools are available, which were restricted to anticholinergic medications, amongst those, one that shows promising results …”

“…Other tools are available, which were restricted to anticholinergic medications, amongst those, one that shows promising results. 24,25…”

Anticholinergic Drug Burden Tools/Scales and Adverse Outcomes in Different Clinical Settings: A Systematic Review of Reviews

“…The chief limitation of the approach taken in this review is the potential for bias introduced by including only previous reviews, rather than seeking out newer empirical studies published in the interim. Some potentially pertinent studies may have been missed by this method and since the completion of the review we have become aware of one such example [80]. However, this potential has been mitigated to a degree by the number of reviews included and their recent publication dates.…”

The Prognostic Value of Anticholinergic Burden Measures in Relation to Mortality in Older Individuals: A Systematic Review and Meta-Analysis

“…Eight ACB measures were used (Han et al, 2001;Carnahan et al, 2006;Hilmer et al, 2007;Boustani et al, 2008;Chew et al, 2008;Rudolph et al, 2008;Durań et al, 2013;Klamer et al, 2017). The most frequently used were the Anticholinergic Cognitive Burden Scale (ACBS; n=9), Anticholinergic Risk Scale (ARS; n=8), Anticholinergic Drug Scale (ADS; n=4) and the Drug Burden Index (anticholinergic) (DBI (antichol) ; n=2).…”