Anticholinergic burden and cognitive function in a large German cohort of hospitalized geriatric patients

Abstract

PurposePrevious studies suggest an association between use of anticholinergic drugs in elderly patients and cognitive impairment. However, there are still limited data on the association of anticholinergic drug use and cognitive impairment as well as contribution of individual drugs to anticholinergic load using large, well-documented patient cohorts treated in geriatric units from Europe.MethodsWe investigated 797,440 prescriptions to 89,579 hospitalized patients treated in geriatric units within the GiB-DAT database. Data of all patients discharged between 1 January 2013 and 30 June 2015 was included. The Anticholinergic Cognitive Burden (ACB) scale was used to classify anticholinergic drugs as definite (score 2 or 3) and possible anticholinergics (score 1). Cognitive function was determined using Mini-Mental State Examination (MMSE) and the standardized scale for dementia (4D+S).ResultsIn two multivariable logistic regression models age, sex, number of drugs and ACB total scores were identified as variables independently associated with cognitive impairment as measured by MMSE (odds ratio per ACB unit 1.114, 95% CI 1.099–1.130) or the diagnosis dementia (odds ratio 1.159 per ACB unit, 95% CI 1.144–1.173, both p < 0.0001). High anticholinergic load was associated with patients with severe cognitive impairment (p < 0.05 for all pairwise comparisons). ACB score 3 anticholinergic drugs contributed 77.9% to the cumulative amount of ACB points in patients with an anticholinergic load of 3 and higher.ConclusionsUsing a cross-sectional study design, a significant positive association between anticholinergic drug load and cognitive impairment in European patients treated in specialised geriatric units was found. The most frequently used definitve anticholinergic drugs were quetiapine, amitriptyline and carbamazepine.

Potentially inappropriate prescriptions of anticholinergics drugs in Alzheimer's disease patients

“…The main anticholinergic drug identified was quetiapine. This finding is similar to that reported in Germany, where it was also found to be the most often prescribed drug, although it was used by a larger proportion of patients . In a study carried out in an Australian population, risperidone was identified as the most frequently prescribed drug .…”

“…According to the Anticholinergic Cognitive Burden Scale scale, at least one drug being taken with anticholinergic properties was identified in 22.9% of patients, similar to the rate reported in Italy (25.8%), but lower than that found in other studies (44.7–50%) . Of these, 11.6% of patients had a severe anticholinergic burden (≥3 points), which is very similar to the rate described in Australia (11.7%) and the USA (12%) .…”

“…Alzheimer's disease was mainly observed in women (67.8%) at a rate similar to that found in studies in North America, Europe and Asia, although with a lower frequency than that reported in France (75.3%) and the USA (81.6%) . The mean age of 81.5 years was comparable to that reported by other studies (79–82 years), with patients aged >85 years being at high risk (OR 2.197, 95% CI 1.159–4.162) of taking drugs with an anticholinergic burden ≥3.…”

“…Toxicity is more commonly observed due to the cumulative anticholinergic burden of multiple prescribed drugs and their metabolites than for a single compound; however, just 3.5% of patients had two or more anticholinergic drugs prescribed at the same time, which was consistent with the results reported by Pfistermeister et al . in Germany …”

Shared biological pathways for frailty and cognitive impairment: A systematic review

“…For every ACB medication added, the Mini-Mental State Exam (MMSE) score decreases 0.33 points over 2 years, risk of cognitive decline is 46% over 6 years (Campbell et al, 2010; Fox et al, 2011a, b), and risk of transitioning from non-frail to frail is 73% (Jamsen et al, 2016). Increased levels of exposure to anticholinergic drugs are correlated with dementia (p = .05 to < .001)(Campbell et al, 2010; Fox et al, 2011a, b; Pfistermeister et al, 2017) and worsening Alzheimer’s disease (AD) (p < .001)(Gray et al, 2015). An interaction was found between ApoE4 carriers and anticholinergic medications with users having the lowest cognitive scores.…”