Anticholinergic Burden and Risk of Stroke and Death in People with Different Types of Dementia

Tan, Edwin C.K.; Eriksdotter, Maria; García-Ptacek, Sara; Fastbom, Johan; Johnell, Kristina

doi:10.3233/jad-180353

Cited by 35 publications

(34 citation statements)

References 31 publications

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“…Our cox proportional hazard models showed that higher anticholinergic burden was associated with higher mortality rates among people with dementia in our cohort. Similar to past studies assessing mortality rates in dementia, we also noted that being of male gender and increased age significantly increases mortality rates (Tan et al, 2018;Garcia-Ptacek et al, 2014;. On the other hand, being married and living in some of the least deprived areas, significantly decreased mortality (Table 3).…”

Section: Discussionsupporting

confidence: 88%

Anticholinergic drug use and risk of mortality for people with dementia in Northern Ireland

McMichael¹,

Zafeiridi²,

Ryan

et al. 2020

Aging & Mental Health

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Objective: Anticholinergic burden refers to the cumulative effect of medications which contain anticholinergic properties. We assessed how anticholinergic burden and different types of anticholinergic medications influence mortality rates among people with dementia in Northern Ireland. Our secondary aim was to determine what demographic characteristics predict the anticholinergic burden of people with dementia. Methods: Data were extracted from the Enhanced Prescribing database for 25,418 people who were prescribed at least one dementia management medication between 2010 and 2016. Information was also extracted on the number of times each available anticholinergic drug was prescribed between 2010 and 2016, allowing the calculation of an overall anticholinergic burden. Cox proportional hazard models were used to determine how anticholinergic burden influenced mortality whilst multilevel model regression determined what demographic characteristics influence overall anticholinergic burden. Results: Of the 25,418 people with dementia, only 15% (n ¼ 3880) had no anticholinergic burden. Diazepam (42%) and risperidone (18%) were the two most commonly prescribed drugs. Unadjusted Cox proportional hazard models indicated that higher anticholinergic burden was associated with significantly higher mortality rates in comparison to people with dementia who had no anticholinergic burden (HR ¼ 1.59: 95% CI ¼ 1.07-2.36). In particular, urological (HR ¼ 1.20: 95% CI ¼ 1.05-1.38) and respiratory (HR ¼ 1.17: 95% CI ¼ 1.08-1.27) drugs significantly increased mortality rates. People with dementia living in areas with low levels of deprivation had significantly lower anticholinergic burden (HR=-.39: 95% CI=-.47:-30). Conclusions: Reducing anticholinergic burden is essential for people with dementia. Further research should address the unfavourable prognosis of people living with dementia in highly deprived areas.

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Section: Discussionsupporting

confidence: 88%

Anticholinergic drug use and risk of mortality for people with dementia in Northern Ireland

McMichael¹,

Zafeiridi²,

Ryan

et al. 2020

Aging & Mental Health

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“…ChEIs have been proven to have symptomatic effects in Alzheimer´s dementia beyond those detected by standard measures of cognition. As previously shown by our group, ChEIs have been associated with reductions in myocardial infarction 28 , stroke 27 and mortality 27 , while anticholinergic medications have been associated with increases in stroke and mortality risk 40 .…”

Section: Discussionsupporting

confidence: 54%

Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality

García-Ptacek

Jönsson

et al. 2021

Neurology

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Objective:To investigate whether Cholinesterase inhibitors (ChEIs) are associated with slower cognitive decline in Alzheimer’s dementia, and decreased risk of severe dementia or death.Methods:Alzheimer’s dementia patients from the Swedish Dementia Registry (SveDem) starting on ChEIs within three months of the dementia diagnosis were included and compared to non-treated Alzheimer’s dementia patients. In a propensity score matched cohort, the association between ChEI-use and cognitive trajectories assessed by MMSE scores were examined with a mixed model, and severe dementia (MMSE<10) or death as outcomes with Cox proportional hazards models.Results:The matched cohort included 11,652 ChEI-users and 5,826 non-users. During an average of 5 years follow up, 255 cases developed severe dementia and 6,055 (35%) died. ChEI-use was associated with higher MMSE at each visit (0.13 MMSE points/year; 95% confidence interval-CI 0.06, 0.20). ChEI-use had a 27% lower risk of death (0.73; CI 0.69, 0.77) compared with non-users. Galantamine was associated with lower risk of death (0.71; CI 0.65, 0.76), lower risk of severe dementia (0.69; CI 0.47-1.00), and had the strongest effect on cognitive decline of all the ChEIs (0.18 MMSE points/year, CI 0.07, 0.28).Conclusions:ChEIs are associated with cognitive benefits which are modest but persist over time and with reduced mortality risk, which could be explained partly by their cognitive effects. Galantamine was the only ChEI demonstrating a significant reduction in the risk of developing severe dementia.Classification of Evidence:This study provides Class III evidence that for patients with Alzheimer’s dementia, ChEIs decrease long term cognitive decline and risk of death, and that galantamine decreases the risk of severe dementia.

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“…Anticholinergics have also been found to be associated with higher mortality in institutionalized elderly, especially in those with coronary disease (Vetrano et al, 2016) due to the greater vulnerability to the proarrhythmic effects of these drugs. A longitudinal study found a dose-dependent association between taking anticholinergics and the risk of stroke and death in elderly people with Alzheimer’s disease, mixed dementia and vascular dementia (Tan et al, 2018) which would parallel to the well-known risk of antipsychotics. Nevertheless, this risk does not seem to be directly associated to the possible anticholinergic effect of antipsychotics, since it is very different among the different drugs (Maust et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Anticholinergic Drugs in Geriatric Psychopharmacology

López-Álvarez¹,

Sevilla‐Llewellyn‐Jones

Agüera-Ortíz³

2019

Front. Neurosci.

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Drugs with anticholinergic action are widely prescribed in the elderly population due to their potential clinical benefits. However, these benefits are limited by adverse effects which may be serious in particular circumstances. This review presents different aspects of the use of anticholinergics in old age with a focus in psychogeriatric patients. We critically review published data on benefits and disadvantages of anticholinergics, which are often controversial. Prevalence, pathophysiology and measurement methods of the anticholinergic action of drugs are discussed. We also present the most important drawbacks resulting from its use, including effects on cognition in healthy and cognitively impaired people, in aged schizophrenia patients, emergence of delirium and psychiatric symptoms, influence in functionality, hospitalization, institutionalization and mortality, and the potential benefits and limitations of their discontinuation. Finally, we suggest practical recommendations for the safe use of anticholinergics in clinical conditions affecting elderly patients, such as dementia, schizophrenia and acute hallucinatory episodes, depression, anxiety, Parkinson’s disease, cardiovascular conditions and urinary incontinence.

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Anticholinergic Burden and Risk of Stroke and Death in People with Different Types of Dementia

Abstract: The use of anticholinergic medicines may be associated with an increased risk of stroke and death in people with dementia. A dose-response relationship was observed. Careful consideration should be made when prescribing medications with anticholinergic properties to people with dementia.

Cited by 35 publications

References 31 publications

Anticholinergic drug use and risk of mortality for people with dementia in Northern Ireland

Anticholinergic drug use and risk of mortality for people with dementia in Northern Ireland

Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality

Anticholinergic Drugs in Geriatric Psychopharmacology

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