Anticholinergic Burden in Children, Adults and Older Adults in Slovenia: A Nationwide Database Study

Lipovec, Nanca Cebron; Jazbar, Janja; Kos, Mitja

doi:10.1038/s41598-020-65989-9

Cited by 25 publications

(20 citation statements)

References 26 publications

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“…These data suggest that already in younger patients, AB might be associated with adverse effects. So far, only a single study has provided a comprehensive overview of the prevalence of AB in all age groups of a population [ 18 ]. However, in this study, age categories were defined broadly and AB prevalences were not stratified by sex within age groups.…”

Section: Introductionmentioning

confidence: 99%

Anticholinergic burden: First comprehensive analysis using claims data shows large variation by age and sex

et al. 2021

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Purpose The cumulative effect of medication inhibiting acetylcholine activity—also known as anticholinergic burden (AB)—can lead to functional and cognitive decline, falls, and death. Given that studies on the population prevalence of AB are rare, we aimed to describe it in a large and unselected population sample. Methods Using the German Pharmacoepidemiological Research Database (GePaRD) with claims data from ~20% of the German population we analyzed outpatient drug dispensations in 2016. Based on the Anticholinergic Cognitive Burden (ACB) scale, we classified persons into four categories and determined the cumulative AB as continuous variable. Results Among 16,470,946 persons (54% female), the prevalence of clinically relevant AB (ACB≥3) was 10% (women) and 7% (men). Below age 40 it was highest in persons ≤18 years (6% both sexes). At older ages (50–59 vs. 90–99 years), prevalence of ACB≥3 increased from 7% to 26% (men) and from 10% to 32% (women). Medication classes contributing to the cumulative AB differed by age: antihistamines, antibiotics, glucocorticoids (≤19 years), antidepressants (20–49 years), antidepressants, cardiovascular medication, antidiabetics (50–64 years), and additionally medication for urinary incontinence/overactive bladder (≥65 years). Medication dispensed by general physicians contributed most to the cumulative AB. Conclusion Although a clinically relevant AB is particularly common in older persons, prevalence in younger age groups was up to 7%. Given the risks associated with AB in older persons, targeted interventions at the prescriber level are needed. Furthermore, risks associated with AB in younger persons should be explored.

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Section: Introductionmentioning

confidence: 99%

Anticholinergic burden: First comprehensive analysis using claims data shows large variation by age and sex

et al. 2021

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“…Anticholinergic medications are commonly prescribed 1 – 3 yet a growing body of evidence has demonstrated that their use is associated with a higher risk of incident cognitive impairment 4 – 6 . This literature has been reviewed multiple times in older adults, whereby anticholinergic medications have been consistently associated with cognitive decline and dementia 7 – 9 .…”

Section: Introductionmentioning

confidence: 99%

“…There are few population-based studies that have assessed the extent to which children are exposed to anticholinergic medicines 1 . Most studies examining anticholinergic medicines in children have focussed on the use of medicine classes for specific indications, for example, asthma or overactive bladder, rather than providing population-based estimates for the use of anticholinergic medicines like the studies in older adults.…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 11% of Australian children have a current diagnosis of asthma 10 and up to 20% of children experience bedwetting 11 so there is potential for a high prevalence of use of anticholinergic medicines to treat these conditions in children. One population based study from Slovenia reported that 20% of children using prescription medicines were dispensed anticholinergic medicines, most commonly antihistamines 1 .…”

Section: Introductionmentioning

confidence: 99%

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The effects of anticholinergic medications on cognition in children: a systematic review and meta-analysis

Ghezzi

Chan

Ellett

et al. 2021

Sci Rep

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Cognitive side effects of anticholinergic medications in older adults are well documented. Whether these poor cognitive outcomes are observed in children has not been systematically investigated. We aimed to conduct a systematic review and meta-analysis on the associations between anticholinergic medication use and cognitive performance in children. Systematic review was conducted using Medline, PsychInfo, and Embase, identifying studies testing cognitive performance relative to the presence versus absence of anticholinergic medication(s) in children. We assessed effects overall, as well as relative to drug class, potency (low and high), cognitive domain, and duration of administration. The systematic search identified 46 articles suitable for meta-analysis. For the most part, random effects meta-analyses did not identify statistically significant associations between anticholinergic exposure and cognitive performance in children; the one exception was a small effect of anticholinergic anti-depressants being associated with better cognitive function (Hedges’ g = 0.24, 95% CI 0.06–0.42, p = 0.01). Anticholinergic medications do not appear to be associated with poor cognitive outcomes in children, as they do in older adults. The discrepancy in findings with older adults may be due to shorter durations of exposure in children, differences in study design (predominantly experimental studies in children rather than predominantly epidemiological in older adults), biological ageing (e.g. blood brain barrier integrity), along with less residual confounding due to minimal polypharmacy and comorbidity in children.

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“…Anticholinergics are commonly used to treat not only urinary incontinence due to overactive bladder (OAB) but also chronic obstructive pulmonary disease (COPD), asthma, Parkinson’s disease, dizziness and motion sickness. Many studies show the ill effects of anticholinergics on cognition resulting in increased morbidity and mortality [ 1 , 2 ]. However, the interaction of anticholinergic medications and cumulative anti-cholinergic burden (ACB) of different medications are not well known in general population and amongst health care professionals [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Staff Awareness of Anti-Cholinergic Burden (ACB) - A Qualitative Cross-Sectional Study in a Tertiary Care Hospital

Soundararajan¹,

Balchandra²

2021

Cureus

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Introduction and hypothesis Anticholinergics are commonly used for a variety of conditions including urinary incontinence. Many studies show the ill effects of anticholinergics on cognition resulting in increased morbidity and mortality. However, the interaction of anticholinergic medications and cumulative anti-cholinergic burden (ACB) of different medications are not well known in general population and amongst health care professionals. Our aim is to study the extent of current awareness of ACB amongst health care professionals which plays a crucial role in educating patients and avoiding these morbidities. Methods A single centre cross-sectional study of 50 health care professionals who participated voluntarily. A questionnaire was designed to assess the knowledge, beliefs and attitudes towards anticholinergic burden and participants were also asked to choose the ACB score for 17 commonly used medications. Results A total of 74% participants admitted to have no understanding of the term ACB, 48% participants prescribe anticholinergics in their daily role, 44% knew that cognition was adversely affected by anticholinergics, and 16% participants were aware of scoring system. Only 16% participants routinely counsel women of cognitive side effects when anticholinergics are started. 86% reported that they would avoid prescribing medications which might affect cognition if possible. If given choice as a patient, 94% would avoid these medications if they were informed of the specific side effects like impaired cognition, physical decline, falls, hospital admissions and increased mortality. Conclusion Anticholinergic burden (ACB) is a serious phenomenon associated with increased morbidity and mortality in the general population as well as elderly population. It is evident from this study that the knowledge and awareness of ACB in our health care staff are still lacking.

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Anticholinergic Burden in Children, Adults and Older Adults in Slovenia: A Nationwide Database Study

Cited by 25 publications

References 26 publications

Anticholinergic burden: First comprehensive analysis using claims data shows large variation by age and sex

Anticholinergic burden: First comprehensive analysis using claims data shows large variation by age and sex

The effects of anticholinergic medications on cognition in children: a systematic review and meta-analysis

Staff Awareness of Anti-Cholinergic Burden (ACB) - A Qualitative Cross-Sectional Study in a Tertiary Care Hospital

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