Anticholinergic Burden, Polypharmacy, and Cognition in Parkinson’s Disease Patients with Mild Cognitive Impairment: A Cross-Sectional Observational Study

Abstract

<b><i>Introduction:</i></b> Anticholinergic burden may be an important risk factor for the cognitive impairment. Especially in polypharmacy, even drugs with low anticholinergic effects may contribute to a significant anticholinergic burden. The drugs with anticholinergic effects are used in treatment of motor and nonmotor symptoms of Parkinson’s disease (PD). Therefore, it is important to screen for polypharmacy and anticholinergic burden in PD patients with mild cognitive impairment (MCI). <b><i>Methods:</i></b> This cross-sectional study was conducted with 58 patients with PD. PD-MCI was diagnosed according to MDS Level 2 Comprehensive Assessment. Cognitive performance (attention – working memory, executive functions, language, memory, and visuospatial functions) of patients was evaluated. The anticholinergic burden was scored by Anticholinergic Cognitive Burden (ACB) Scale, Anticholinergic Risk Scale (ARS), and Anticholinergic Drug Scale (ADS). <b><i>Results:</i></b> There was no significant difference in anticholinergic burden between PD-MCI and PD-normal cognition. A significant concordance was observed between ACB, ARS, and ADS scores (<i>p</i> < 0.001; Kendall’s W = 0.653). While the variable predicting anticholinergic burden was the total number of drugs for ACB and ADS scales, it was the number of antiparkinson drugs for ARS scale. <b><i>Conclusion:</i></b> Patients with PD are at high risk for polypharmacy and anticholinergic burden. Anticholinergic burden should be considered in the selection of drugs, especially for comorbidities in patients with PD. No significant correlation was found between the cognition and anticholinergic burden in patients with PD-MCI. Although the risk scores of antiparkinson and other drugs were different among the 3 scales, significant concordance was observed between scales.

Risk factors for dementia in Parkinson’s Disease — the overuse of anticholinergic drugs

“…In two studies using ACB, 15.5-18.5% of patients had more than 2 points and 41.5-46.3% took at least one anticholinergic drug; these seem to be similar results to those in our study [42][43][44]. Geriatric patients from the same area of Poland hospitalised in a geriatric ward had a lower anticholinergic burden (ACB ≥ 3 13.98%, ACB ≥ 1 40.73%) than PD patients from our study, which might suggest that the topic is especially relevant for PD patients [45].…”

“…On the other hand, some studies have not found any association between anticholinergics and cognitive decline in PD patients. However, their authors did suggest that this could be related to factors such as a low anticholinergic burden in the analysed group or a short follow-up [41][42][43].…”

Anticholinergic burden among in-patients: a cross-sectional study on prevalence, determinants, and impact on mortality in Ethiopia

“…In addition to the use of medicines with high ACB scores, high ACB may also result from the concomitant use of several low-risk medicines. 22 Hence, it is expected that there is a positive correlation between the number of medicines an individual takes and the resultant ACB. This is in agreement with previous reports.…”

Chaudhuri’s Dashboard of Vitals in Parkinson’s syndrome: an unmet need underpinned by real life clinical tests

“…Anticholinergic burden has been linked to functional and cognitive decline in PwP, with possible contribution to overt dementia, and potential side effects including constipation, agitation, urinary retention, and delirium ( 203 , 204 ). The use of anticholinergic indexes, such as Anticholinergic Drug Scale (ADS) and the Drug Burden Index - Anticholinergic Component (DBI-ACh), are useful clinical tool for such assessments, with ADS being shown to correlate with serum anticholinergic activity ( 203 , 205 , 206 ).…”