Anticholinergic Burden, Sleep Quality and Health Outcomes in Malaysian Aged Care Home Residents

Kumar, Suresh; Hasan, Syed Shahzad; Wong, Pei Se; Chong, David Weng Kwai; Kairuz, Therése

doi:10.3390/pharmacy7040143

Cited by 12 publications

(8 citation statements)

References 45 publications

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“…While effective, BoNT therapy is highly specific for alleviating motor dysfunction, due to its focal application. Although, while certain drugs like benzodiazepines or anticholinergics can be used to mitigate the motor symptoms of dystonia (139), they typically also have significant effects on sleep (140,141). In contrast, one way that DBS is thought to function is by causing an "informational lesion" of synapses (142), which could be used to correct convergent sites of dysfunction, for example, at the cerebellar nuclei.…”

Section: Discussionmentioning

confidence: 99%

Potential Interactions Between Cerebellar Dysfunction and Sleep Disturbances in Dystonia

Leon

Sillitoe²

2022

Dystonia

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Dystonia is the third most common movement disorder. It causes debilitating twisting postures that are accompanied by repetitive and sometimes intermittent co- or over-contractions of agonist and antagonist muscles. Historically diagnosed as a basal ganglia disorder, dystonia is increasingly considered a network disorder involving various brain regions including the cerebellum. In certain etiologies of dystonia, aberrant motor activity is generated in the cerebellum and the abnormal signals then propagate through a “dystonia circuit” that includes the thalamus, basal ganglia, and cerebral cortex. Importantly, it has been reported that non-motor defects can accompany the motor symptoms; while their severity is not always correlated, it is hypothesized that common pathways may nevertheless be disrupted. In particular, circadian dysfunction and disordered sleep are common non-motor patient complaints in dystonia. Given recent evidence suggesting that the cerebellum contains a circadian oscillator, displays sleep-stage-specific neuronal activity, and sends robust long-range projections to several subcortical regions involved in circadian rhythm regulation, disordered sleep in dystonia may result from cerebellum-mediated dysfunction of the dystonia circuit. Here, we review the evidence linking dystonia, cerebellar network dysfunction, and cerebellar involvement in sleep. Together, these ideas may form the basis for the development of improved pharmacological and surgical interventions that could take advantage of cerebellar circuitry to restore normal motor function as well as non-motor (sleep) behaviors in dystonia.

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Section: Discussionmentioning

confidence: 99%

Potential Interactions Between Cerebellar Dysfunction and Sleep Disturbances in Dystonia

Leon

Sillitoe²

2022

Dystonia

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“…Deprescribing interventions aimed at reducing acute care utilization among patients with medical complexity is an example. High-risk medication may reduce overall capacity (e.g., sleep, physical activity, cognition) in medically-complex older adults with mild cognitive impairment [ 10 , 12 , 13 , 14 , 15 ], which can negatively impact the ability to manage acute health stressors, thereby increasing acute care utilization [ 15 ]. Thus, there is a need to look for opportunities aimed at reducing acute care utilization among patients with suspected cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

“…There are many contributors to cognitive impairment in this population, not only normative cognitive decline, but also factors that affect cognition in the short term, such as medications. While there is significant evidence demonstrating the negative impact of anticholinergic medications on cognition, physical function [ 10 ], and side effects (such as blurred vision, constipation, dry mouth, falls) [ 11 ], the association with sleep quality remains overlooked [ 12 ]. Poor sleep quality may contribute to increased fatigue and reduced daytime functioning [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Potential Targets for Deprescribing in Medically Complex Older Adults with Suspected Cognitive Impairment

et al. 2022

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Deprescribing may be particularly beneficial in patients with medical complexity and suspected cognitive impairment (CI). We describe central nervous system (CNS) medication use and side effects in this population and explore the relationship between anticholinergic burden and sleep. We conducted a cross-sectional analysis of baseline data from a pilot randomized-controlled trial in older adult veterans with medical complexity (Care Assessment Need score > 90), and suspected CI (Telephone Interview for Cognitive Status score 20–31). CNS medication classes included antipsychotics, benzodiazepines, H2-receptor antagonists, hypnotics, opioids, and skeletal muscle relaxants. We also coded anticholinergic-active medications according to their Anticholinergic Cognitive Burden (ACB) score. Other measures included self-reported medication side effects and the Pittsburgh Sleep Quality Index (PSQI). ACB association with sleep (PSQI) was examined using adjusted linear regression. In this sample (N = 40), the mean number of prescribed CNS medications was 2.2 (SD 1.5), 65% experienced ≥ 1 side effect, and 50% had an ACB score ≥ 3 (high anticholinergic exposure). The ACB score ≥ 3 compared to ACB < 3 was not significantly associated with PSQI scores (avg diff in score = −0.1, 95% CI −2.1, 1.8). Although results did not demonstrate a clear relationship with worsened sleep, significant side effects and anticholinergic burden support the deprescribing need in this population.

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“…Furthermore, higher prevalence rates of 36.4% (20/55) and 48.4% (30/62) were reported in Malaysia and the United States, respectively. 39 , 40 These disparities could be attributed to differences in physicians’ prescribing culture, anticholinergic burden assessment methodologies, and cutoffs.…”

Section: Discussionmentioning

confidence: 99%

Older adults’ exposure to anticholinergic medications: Implications for pharmaceutical care for Nigerian older adults

Okoro

Idris

2022

The Journal of Medicine Access

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Introduction: Anticholinergic medications which are commonly prescribed to older adults can produce more pronounced adverse effects compared to the younger population. Objectives: To investigate the prevalence of polypharmacy, describe the prescription patterns of anticholinergic medications, determine the prevalence of exposure to high-risk anticholinergic cognitive burden (ACB) medications, and identify the potential predictors of exposure to high-risk ACB medications in older adults in a Nigerian secondary hospital. Methods: This cross-sectional study that included older adults prescribed at least one anticholinergic medication was conducted at a secondary care hospital in Nigeria. The study data were initially summarized using descriptive statistics, whereas multivariable logistic regression analysis was used to identify the potential predictors of exposure to high-risk ACB medications. In this study, the cumulative ACB scores were dichotomized into low risk (score 1–2) and high risk (score ⩾ 3). A p value less than 0.05 was considered to be statistically significant. Results: A total of 256 older adults were included in this study; 113 (44.1%) had polypharmacy, whereas 26.6% (188/256) were exposed to high-risk ACB medications. Of a total of 391 anticholinergic medications used by the population, furosemide (36.57%) was the most commonly prescribed. The adjusted multivariable logistic regression analysis indicated that patients who had acute diseases were 2.5 times (adjusted odds ratio (AOR) = 2.49, 95% confidence interval (CI): 1.40–4.45) more likely to be exposed to high-risk ACB medications than those with chronic diseases. Conclusion: The study demonstrates a high prevalence of polypharmacy and exposure to high-risk ACB medications suggesting the need for pharmaceutical care in this high-risk population. Older adults’ exposure to high-risk ACB medications was significantly associated with prescriptions for acute diseases.

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Anticholinergic Burden, Sleep Quality and Health Outcomes in Malaysian Aged Care Home Residents

Cited by 12 publications

References 45 publications

Potential Interactions Between Cerebellar Dysfunction and Sleep Disturbances in Dystonia

Potential Interactions Between Cerebellar Dysfunction and Sleep Disturbances in Dystonia

Potential Targets for Deprescribing in Medically Complex Older Adults with Suspected Cognitive Impairment

Older adults’ exposure to anticholinergic medications: Implications for pharmaceutical care for Nigerian older adults

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