Anticholinergic Drug Burden Tools/Scales and Adverse Outcomes in Different Clinical Settings: A Systematic Review of Reviews

Welsh, Tomas; Wardt, Veronika van der; Ojo, Grace; Gordon, Adam L; Gladman, John

doi:10.1007/s40266-018-0549-z

Cited by 103 publications

(133 citation statements)

References 79 publications

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“…We used the ACB scale to identify anticholinergic medications, however this is one of 18 different scales that all vary in their content and how they are derived and how anticholinergic activity is quanti ed [34]. However, the scales closely agree on which medications they classify as potently anticholinergic.…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

Grossi

Richardson

Savva

et al. 2020

Preprint

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Background: Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality, and their use should be limited in older people. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability.Methods: We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990-1993 (N=7,635) and 2008-2011 (N=7,762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score=3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Results: Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2-6.3%) of the older population in 1990-93 to 9.9% (9.3-10.7%) in 2008-11, adjusted odds ratio of 1.90 (95%CI 1.67 – 2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergic in CFAS II (16.5% [95%CI 12.0-22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Conclusions: Use of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects.

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Section: Strengths and Weaknessesmentioning

confidence: 99%

Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

Grossi

Richardson

Savva

et al. 2020

Preprint

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“…We addressed this issue by controlling for hyperlipidemia, stroke, and hypertension in our multivariable regression model. Several scales other than the ACB scale have been used to measure anticholinergic burden . Our results could have been different if a different scale had been used .…”

Section: Discussionmentioning

confidence: 79%

“…Several scales other than the ACB scale have been used to measure anticholinergic burden . Our results could have been different if a different scale had been used . In addition, misclassification of dementia was possible because we were unable to obtain neurologic examinations, cognitive assessment, and laboratory data such as brain images and biomarker information used to diagnose dementia .…”

Section: Discussionmentioning

confidence: 89%

Association between Anticholinergic Medication Use and Risk of Dementia among Patients with Parkinson's Disease

Sheu

Tsai²,

Erickson

et al. 2019

Pharmacotherapy

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Study Objectives To evaluate the association between anticholinergic medication use, categorized by anticholinergic cognitive burden (primary objective) and cumulative dose (secondary objective), and the risk of developing dementia among patients with Parkinson's disease. Design Retrospective cohort study with an active comparator design. Data Source National Health Insurance Research Database in Taiwan (2001–2011). Patients A total of 1232 adults with Parkinson's disease who were diagnosed between 2002 and 2004 and taking at least one antiparkinson medication during this period were included. Of these patients, 694 were exposed to anticholinergic medications categorized as mild (reference group), and 538 were exposed to anticholinergic medications categorized as moderate or severe (exposure group). Measurements and Main Results Exposure to different types of anticholinergic medications was categorized by using the Anticholinergic Cognitive Burden (ACB) scale, and cumulative doses of anticholinergic medications were measured by using the cumulative minimum doses (cMD) method. Associations between anticholinergic medication use and risk of dementia were assessed by multivariable Cox proportional hazards models. The type of anticholinergics used (moderate or severe vs mild ACB) was not significantly associated with an increased risk of developing dementia (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.72–1.27). After adjusting for confounders, a high cumulative dose of anticholinergic drug (> 1095 cumulative minimum doses [cMDs]) was found to be significantly associated with an increased risk of developing dementia when compared with a low cumulative dose of anticholinergic drug (≤ 90 cMDs) (HR 3.06, 95% CI 1.35–6.97). Conclusion Among patients with Parkinson's disease in Taiwan, those with a high cumulative dose of anticholinergics had an increased risk of being diagnosed with dementia. Physicians should consider prescribing the lowest therapeutic dose of anticholinergic medication when making treatment decisions for patients with Parkinson's disease.

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“…First‐generation sedating antihistamines are highly anticholinergic and therefore best avoided by older adults in most circumstances. Anticholinergic burden increases the risk of dry mouth, constipation, confusion, cognitive impairment, falls and hospitalization . Many different drugs contribute varying degrees of anticholinergic activity, which may have a summative effect.…”

mentioning

confidence: 99%

“…Anticholinergic burden increases the risk of dry mouth, constipation, confusion, cognitive impairment, 5 falls and hospitalization. 6 Many different drugs contribute varying degrees of anticholinergic activity, which may have a summative effect. A patient already taking one or more medications with anticholinergic properties for other conditions will be at increased risk from the addition of a first-generation antihistamine to their medication regime.…”

mentioning

confidence: 99%

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Mate

2019

Br J Dermatol

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Anticholinergic Drug Burden Tools/Scales and Adverse Outcomes in Different Clinical Settings: A Systematic Review of Reviews

Cited by 103 publications

References 79 publications

Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

Association between Anticholinergic Medication Use and Risk of Dementia among Patients with Parkinson's Disease

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