Anticholinergic burden in adult and elderly people with intellectual disabilities: Results from an Italian multicenter cross-sectional study

Vreese, Luc Pieter De; Mantesso, Ulrico; Bastiani, Elisa De; Marangoni, Annachiara; Weger, Elisabeth; Gomiero, Tiziano

doi:10.1371/journal.pone.0205897

Cited by 26 publications

(36 citation statements)

References 49 publications

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“…A high rate of use of antidepressants has been described also in other European countries [ 51 – 55 ]. This aspect has a fundamental importance because, despite the potential of antidepressants for neurogenesis [ 56 , 57 ], the use of drugs endowed with anticholinergic burden can worsen cognitive decline, increase the risk of falls, institutionalization, and mortality [ 58 – 65 ]. Therefore, antidepressants in demented patients should be prescribed only after appropriate diagnosis and with regular follow-up, since the efficacy and safety of these drugs still awaits support from large, rigorous clinical trials [ 66 , 67 ].…”

Section: Discussionmentioning

confidence: 99%

Pattern of treatment of behavioural and psychological symptoms of dementia and pain: evidence on pharmacoutilization from a large real-world sample and from a centre for cognitive disturbances and dementia

Scuteri

Vulnera²,

Piro³

et al. 2020

Eur J Clin Pharmacol

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Purpose Data concerning the number of diagnoses and of the drugs prescribed to patients affected by dementia are still scarce. Here we test whether or not (1) prescription of symptomatic drugs against Alzheimer’s disease (AD) may approximate the number of patients affected by dementia in Italy and (2) adherence to this treatment affects the pattern of prescription of drugs (i.e. antipsychotics and antidepressants) for behavioural and psychological symptoms of dementia (BPSD) and the previously reported limited prescription of analgesics. Methods This retrospective observational study concerns 84,235 subjects older than 60 years and registered in the provincial prescription database of the health district of Cosenza accounting for a population of 298,000 inhabitants. The prescribing pattern of antipsychotics, antidepressants, and analgesics has been investigated in patients receiving concurrent prescriptions of acetylcholinesterase inhibitors (AChEI) and/or memantine. Data from a single centre for cognitive disturbances and dementia (CDCD) in the same health district were used to explore at which stage dementia was diagnosed. The study was approved by Calabria Region Ethical Committee no. 31/2017 and registered on October 31, 2017. Results The data show that 859 patients are treated with AChEI and/or memantine; 420 patients (48.89%) receive at least 80% of the recommended medications. CDCD data indicate a delay in dementia diagnosis, which often was made when the patients were moderately to severely demented (Mini Mental State Examination, MMSE ≤ 20). Adherence did not influence prescription of most of the drugs explored, but use of non-steroidal anti-inflammatory drugs was higher in non-adherent patients. Antipsychotics and antidepressants are frequently used (20.61–20.71% and 42.37–51.43%, respectively), and this, at least in part, might stem from the observed under-treatment of chronic pain (opioids are prescribed in the 4.76% and 12.46% of adherent and non-adherent patients and gabapentin and pregabalin are used in the 4.29% and 4.07% of adherent and non-adherent patients respectively), resulting in more frequent BPSD. 16.43% of patients receive antipsychotics for longer than 6–12 weeks. Conclusion This 2-year period study, including a wide cohort of community demented patients, shows that dementia is diagnosed late and that prevalence of BPSD prescriptions is high and not impacted by adherence to anti-dementia drugs. The rate of prescription of potentially harmful antipsychotics and antidepressants appears to be high though whether the concomitantly observed limited prescription of analgesics might be a contributing factor needs to be further investigated. Our data support the development of strategies to improve the management of BPSD.

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Section: Discussionmentioning

confidence: 99%

Pattern of treatment of behavioural and psychological symptoms of dementia and pain: evidence on pharmacoutilization from a large real-world sample and from a centre for cognitive disturbances and dementia

Scuteri

Vulnera²,

Piro³

et al. 2020

Eur J Clin Pharmacol

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“…So, whenever urinary UI is detected in the old aged group if walking speed is also decreased, geriatric evaluation may result in detection of related geriatric syndromes which will increase in survival of patients, increase in quality of life, reduce polypharmacy, decrease falls and fall-related fractures, and decrease delirium incidence. In addition, anticholinergic drugs used for the treatment of UI, frequently results in decline in functional status, increase in delirium and dementia, increase in falls and depression and most important of all increase in mortality by its mechanism of action, so before starting drug treatment, geriatrician referral might help in excluding or detection of geriatric syndromes which is essential especially UI is a symptom or complication of an underlying geriatric syndrome (36)(37)(38). Lastly, most recently, an article was published in JAMA, with 3.5 million individuals of up to 20 years of follow up.…”

Section: Discussionmentioning

confidence: 99%

Association Between Walking Speed and Urinary Incontinence in the Older Women. Which Patients Should be Referred to Geriatricians?

Atmış

Guler

2020

Gynecol Obstet Reprod Med

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OBJECTIVE: Primary end-point of this study was to detect if there is an association between walking speed and urinary incontinence in older women and secondarily to detect an association between urinary incontinence with other geriatric syndromes.STUDY DESIGN: This is a prospective and cross-sectional study. Three hundred and eighty-nine old aged women admitted to the Geriatrics Department of Ankara University were enrolled and urinary incontinence and type of urinary incontinence, Handgrip strength test, Timed up and Go test, Katz Index of Independence in Activities of Daily Living, Lawton Index of Instrumental Activities of Daily Living, Mini Nutritional Assessment, Mini-Mental State Evaluation, Geriatric Depression Scale, Body Mass Index (BMI) of these participants were recorded. Association of urinary incontinence and these parameters were analyzed. RESULTS: The median age of the study population was 68 (58-86 years of age). Two hundred and fifty-eight (66.32%) had hypertension, 122 (31.36%) had diabetes mellitus, 51 (13.11%) had asthma/Chronic obstructive lung disease, 49 (12.59%) had coronary artery disease and 9 (2.31%) had cerebrovascular disease. One hundred and seventy-eight (45.7%) patients had urinary incontinence (88 urge, 55 stress, 35 mixed). One hundred and eight (27.76%) of patients had Mini-Mental State Evaluation score ≤23. Patients with urinary incontinence detected to have a longer duration of Timed Up and Go test, higher Geriatric Depression Scale score and BMI with p-values 0.005, 0.004, and <0.01 respectively; and lower Activities of Daily Living (Katz-Activities of Daily Living) score with a p-value of <0.01 results. Mini-Mental State Evaluation and Mini Nutritional Assessment scores were not statistically different between the continent and incontinent group.CONCLUSION: Whenever urinary incontinence is detected in an older woman, geriatrician referral should be considered since urinary incontinence is associated with decreased walking speed, Handgrip strength test, Activities of Daily Living, Instrumental Activities of Daily Living or increased Geriatric Depression Scale; any of which is a symptom or result of at least one geriatric syndrome.

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“…For drug combinations, ACB scores of the components were recorded individually. A total ACB score > 3 is known to be significantly associated with adverse outcomes 34 …”

Section: Methodsmentioning

confidence: 99%

Anticholinergics May Carry Significant Cognitive and Gait Burden in Parkinson's Disease

Rajan

Saini

Verma

et al. 2020

Movement Disord Clin Pract

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Background Background: Anticholinergic drugs are associated with significant cognitive and other adverse events in older adults, including those with Parkinson's disease (PD). Anticholinergic effects are considered lesser in younger individuals and the burden and outcomes in younger patients with PD are unknown. Objectives Objectives: To determine the cumulative anticholinergic burden in a cohort of younger of patients with PD and to correlate the same with cognitive impairment and freezing of gait (FOG). Methods Methods: We conducted a cross-sectional study to identify the cumulative anticholinergic burden from medications prescribed to patients with PD. Two standard scales, the Anticholinergic Cognitive Burden (ACB) scale and the ACB score, were used to calculate the anticholinergic burden from prescriptions. We identified commonly prescribed drugs contributing to anticholinergic effects and correlated the cumulative ACB score with cognitive impairment (Movement Disorder Society-Unified Parkinson's Disease Rating Scale item 1.1) and FOG (Movement Disorder Society-Unified Parkinson's Disease Rating Scale items 2.13 and 3.11). Results Results: We recruited 287 patients with PD (68.9% male) with a mean age of 56.9 AE 11.8 years and a duration of symptoms 6.3 AE 6.9 years. Median ACB score was 4 (range 0-12). A total of 164 (58.4%) patients had total ACB score > 3. ACB score > 3 was independently associated with cognitive impairment (Odds Ratio, 2.55; 95% confidence interval, 1.43-4.53; P < 0.001) and FOG using patient-reported measures (Odds Ratio, 3.192; 95% Confidence Interval, 1.68-6.07; P < 0.001) and objective measures (odds ratio, 2.41; 95% confidence interval, 1.27-4.6, P = 0.007). Conclusion Conclusion: Patients with PD are exposed to significant anticholinergic burden from drugs prescribed for PD and non-PD indications. Higher anticholinergic burden is associated with cognitive impairment and FOG even in younger patients with PD. Anticholinergics are a common class of drugs used to treat the symptoms of Parkinson's disease (PD), particularly tremors. Anticholinergic drugs are often used in the early stages of PD, when symptoms are mild, and more than 50% of prescriptions to patients with PD across healthcare settings contain these drugs. 1 Levodopa in combination with a peripheral decarboxylase inhibitor is the mainstay of treatment in PD, and other medications such as dopamine agonists, monoamine oxidase-B inhibitors, and catechol-O-methyl transferase inhibitors maybe used additionally as monotherapy or add ons. Some of these drugs also have additional anticholinergic effects along with their major effects on dopaminergic neurotransmission. In addition to these, patients with PD may also be prescribed drugs with primary or secondary anticholinergic effects for non-PD indications, such as psychiatric symptoms and other medical comorbidities. 2 Primarily anticholinergic drugs and the secondary anticholinergic properties of drugs prescribed for PD and non-PD indications can contribute to the overall anticho...

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Anticholinergic burden in adult and elderly people with intellectual disabilities: Results from an Italian multicenter cross-sectional study

Cited by 26 publications

References 49 publications

Pattern of treatment of behavioural and psychological symptoms of dementia and pain: evidence on pharmacoutilization from a large real-world sample and from a centre for cognitive disturbances and dementia

Pattern of treatment of behavioural and psychological symptoms of dementia and pain: evidence on pharmacoutilization from a large real-world sample and from a centre for cognitive disturbances and dementia

Association Between Walking Speed and Urinary Incontinence in the Older Women. Which Patients Should be Referred to Geriatricians?

Anticholinergics May Carry Significant Cognitive and Gait Burden in Parkinson's Disease

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