Anticholinergic Drug Exposure and the Risk of Dementia

Coupland, Carol; Hill, Trevor; Dening, Tom; Morriss, Richard; Moore, Michael; Hippisley‐Cox, Julia

doi:10.1001/jamainternmed.2019.0677

Cited by 477 publications

(435 citation statements)

References 45 publications

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“…However, the association of dementia risk with diabetes mellitus found in previous studies was not evident among the top predictive features [30]. Anticholinergic drug exposure has also been identified as a risk factor for dementia [31]. Anticholinergic drugs figured prominently in the list of top predictive features in our models as well (Supplementary Material D).…”

Section: Discussionmentioning

confidence: 70%

Machine learning models to predict onset of dementia: A label learning approach

Nori

Hane

Crown

et al. 2019

A&D Transl Res & Clin Interv

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Introduction The study objective was to build a machine learning model to predict incident mild cognitive impairment, Alzheimer's Disease, and related dementias from structured data using administrative and electronic health record sources. Methods A cohort of patients (n = 121,907) and controls (n = 5,307,045) was created for modeling using data within 2 years of patient's incident diagnosis date. Additional cohorts 3–8 years removed from index data are used for prediction. Training cohorts were matched on age, gender, index year, and utilization, and fit with a gradient boosting machine, lightGBM. Results Incident 2‐year model quality on a held‐out test set had a sensitivity of 47% and area‐under‐the‐curve of 87%. In the 3‐year model, the learned labels achieved 24% (71%), which dropped to 15% (72%) in year 8. Discussion The ability of the model to discriminate incident cases of dementia implies that it can be a worthwhile tool to screen patients for trial recruitment and patient management.

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Section: Discussionmentioning

confidence: 70%

Machine learning models to predict onset of dementia: A label learning approach

Nori

Hane

Crown

et al. 2019

A&D Transl Res & Clin Interv

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“…Furthermore, a recent study demonstrated that PD patients with a high cumulative dose of anticholinergics had an increased risk of being diagnosed with dementia . In addition, a recently published case‐control study demonstrated in a cohort of elderly patients that exposure to several types of strong anticholinergic drugs was associated with an increased risk of dementia . This further suggests that providers should be cautious about anticholinergic drug usage in the PD patient population.…”

Section: Discussionmentioning

confidence: 99%

“…11 In addition, a recently published case-control study demonstrated in a cohort of elderly patients that exposure to several types of strong anticholinergic drugs was associated with an increased risk of dementia. 13 This further suggests that providers should be cautious about anticholinergic drug usage in the PD patient population. Overall, levodopa prescribing did not change significantly from 2010 to 2017.…”

Section: Discussionmentioning

confidence: 99%

“…Although the most recent study did not demonstrate disease‐modifying effect of the earlier initiation of levodopa, there was also no deleterious effect . Furthermore, recent work has demonstrated risks with the use of anticholinergic medications …”

mentioning

confidence: 99%

“…10 Furthermore, recent work has demonstrated risks with the use of anticholinergic medications. [11][12][13][14] Despite a large number of data on the efficacy of various pharmacological interventions in PD derived from well-designed controlled studies, there is still a paucity of information on the real-life use of various classes of PD therapeutics. Using the Parkinson's Foundation Quality Improvement Initiative registry collected at participating expert care centers, we analyzed the recent changes in the prescribing practices for the motor symptoms of PD as well as the present-day prescribing landscape.…”

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confidence: 99%

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Changes in Prescribing Practices of Dopaminergic Medications in Individuals with Parkinson's Disease by Expert Care Centers from 2010 to 2017: The Parkinson's Foundation Quality Improvement Initiative

Dubaz

Cubillos

et al. 2019

Movement Disord Clin Pract

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Background During the past decade, there has been increasing awareness of the side effects of dopamine agonists (DAs), including impulse control disorders. We hypothesized that there may be a shift toward more conservative use of DAs. Objective To explore the change in prescribing practices for dopaminergic medications in Parkinson's disease between 2010 and 2017. Methods Data were collected from the Parkinson's Foundation Quality Improvement Initiative registry. Baseline characteristics were compared between the 2010 and 2017 cohorts using chi‐squared tests for discrete and t tests for continuous variables. Logistic regressions were conducted for each class of medications to assess the effect of time points (2010 vs. 2017) and prespecified covariates on the probability of prescribing. Results A total of 2,717 participants from 2010 and 2,900 participants from 2017 were included in the analysis. Mean (standard deviation) age was 67.4 (10) and 68.7 (9.3) for the 2010 and 2017 cohorts, respectively (P < 0.0001). After controlling for baseline characteristics, DA use was unchanged (P = 0.1172). The odds of using monoamine oxidase B inhibitors was 52% higher in 2017 than in 2010 (P < 0.0001), 38% lower for catechol‐O‐methyltransferase inhibitors (P < 0.0001), 25% lower for amantadine (P < 0.0001), and 31% lower for anticholinergics (P = 0.0153). There was no difference in the utilization of levodopa in the 2 cohorts (86.1% vs. 86.2%; P = 0.5783). Conclusions Despite increasing awareness of impulse control disorders, there has been no reduction in the use of DAs during the past decade. Overall, there is less utilization of adjunctive classes of drugs except for an increase in the use of monoamine oxidase B inhibitors.

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Preventing Alzheimer Disease by Deprescribing Anticholinergic Medications

2019

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Campbell NL, Maidment I, Fox C, Khan B, Boustani M. The 2012 update to the anticholinergic cognitive burden scale. J Am Geriatr Soc. 2013;61 (S1):S142-S143. 36. Kontopantelis E, Stevens RJ, Helms PJ, Edwards D, Doran T, Ashcroft DM. Spatial distribution of clinical computer systems in primary care in England in 2016 and implications for primary care electronic medical record databases: a cross-sectional population study.

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Anticholinergic Drug Exposure and the Risk of Dementia

Cited by 477 publications

References 45 publications

Machine learning models to predict onset of dementia: A label learning approach

Machine learning models to predict onset of dementia: A label learning approach

Changes in Prescribing Practices of Dopaminergic Medications in Individuals with Parkinson's Disease by Expert Care Centers from 2010 to 2017: The Parkinson's Foundation Quality Improvement Initiative

Preventing Alzheimer Disease by Deprescribing Anticholinergic Medications

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