Effect of anticholinergic burden on the development of dementia in older adults with subjective cognitive decline

Naharci, Mehmet İlkin; Cintosun, Umit; Öztürk, Ahmet; Öztin, Hasan; Türker, Türker; Bozoğlu, Ergün; Doruk, Huseyin

doi:10.1080/24750573.2017.1358130

Cited by 9 publications

(6 citation statements)

References 34 publications

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“…The 104 validation studies consisted of 1 RCT (good quality) [ 98 ], 74 cohort studies (50 good and 24 poor quality) [ 33 – 36 , 41 , 44 , 54 , 55 , 57 , 59 , 61 – 66 , 70 – 75 , 77 , 78 , 80 , 81 , 83 – 97 , 100 , 103 – 108 , 112 – 115 , 117 , 119 , 120 , 123 , 124 , 129 , 131 – 137 , 139 , 141 – 146 , 148 , 149 ], 9 case-control studies (6 good, 1 fair and 2 poor quality) [ 56 , 67 – 69 , 102 , 110 , 118 , 130 , 147 ] and 20 cross-sectional studies (2 good and 18 poor quality) [ 39 , 53 , 58 , 60 , 76 , 79 , 82 , 99 , 101 , 109 , 111 , 116 , 121 , 122 , 125 – 128 , 138 , 140 ] (Appendix 6 ). More than half of the studies were judged to be of good quality (60 out of 104).…”

Section: Resultsmentioning

confidence: 99%

Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review

Lisibach

Benelli

Ceppi

et al. 2020

Eur J Clin Pharmacol

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Purpose Older people are at risk of anticholinergic side effects due to changes affecting drug elimination and higher sensitivity to drug’s side effects. Anticholinergic burden scales (ABS) were developed to quantify the anticholinergic drug burden (ADB). We aim to identify all published ABS, to compare them systematically and to evaluate their associations with clinical outcomes. Methods We conducted a literature search in MEDLINE and EMBASE to identify all published ABS and a Web of Science citation (WoS) analysis to track validation studies implying clinical outcomes. Quality of the ABS was assessed using an adapted AGREE II tool. For the validation studies, we used the Newcastle-Ottawa Scale and the Cochrane tool Rob2.0. The validation studies were categorized into six evidence levels based on the propositions of the Oxford Center for Evidence-Based Medicine with respect to their quality. At least two researchers independently performed screening and quality assessments. Results Out of 1297 records, we identified 19 ABS and 104 validations studies. Despite differences in quality, all ABS were recommended for use. The anticholinergic cognitive burden (ACB) scale and the German anticholinergic burden scale (GABS) achieved the highest percentage in quality. Most ABS are validated, yet validation studies for newer scales are lacking. Only two studies compared eight ABS simultaneously. The four most investigated clinical outcomes delirium, cognition, mortality and falls showed contradicting results. Conclusion There is need for good quality validation studies comparing multiple scales to define the best scale and to conduct a meta-analysis for the assessment of their clinical impact.

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Section: Resultsmentioning

confidence: 99%

Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review

Lisibach

Benelli

Ceppi

et al. 2020

Eur J Clin Pharmacol

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“…In this study, the mACB score reduction was consistent with the reduction in PIMs (which include anticholinergic medications). Overall the mACB score was 3 (range 0 to 15), and this is a clinically significant result for PWD because a cumulative score of 3 or more is reported to indicate a potential harmful anticholinergic burden [41].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Potentially Inappropriate Medications for People with Dementia at Admission and Discharge during An Unplanned Admission to Hospital: Results from the SMS Dementia Study

et al. 2019

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People with dementia (PWD) and cognitive impairment are particularly vulnerable to medication problems, and unplanned admission to hospital presents an opportunity to address polypharmacy, potentially inappropriate medications (PIMs) and anticholinergic burden. This study aimed to compare PIMS and other medication data for PWD to determine whether these changed during hospitalization. Medications documented in patient’s records at admission and discharge were evaluated for PWD recruited to phase one of a prospective quasi-experimental pre/post-controlled trial that was conducted at two regional hospitals in NSW, Australia. The study sample included PWD or cognitive impairment having an unplanned admission to hospital. Data were collected using a purpose developed audit tool for medications and PIMs, and a Modified Anticholinergic Burden Scale. Total participants were 277, and results determined that the cognitive status of PWD is not always detected during an unplanned admission. This may make them more vulnerable to medication problems and poor outcomes. Polypharmacy and PIMS for PWD were high at admission and significantly reduced at discharge. However, PWD should be routinely identified as high risk at admission; and there is potential to further reduce polypharmacy and PIMs during admission to hospital, particularly psychotropic medications at discharge. Future studies should focus on evaluating targeted interventions designed to increase medication safety for PWD.

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“…AC medication use has been associated with subjective cognitive decline among community‐dwelling adults (aged 47–91 years; M = 65.2 (8.6) at risk for AD (based on APOE ε4 carrier status and/or family history of dementia) (Margolis et al, 2021). Among adults ≥65 years with subjective cognitive decline, high ACB (≥3) is associated with a more than four‐fold increased risk for dementia development (Naharci et al, 2017). Thus, the results reported here indicate that studies of aging and cognition in autism should take into consideration the potential impacts of AC medication use on self‐report or performance‐based measures of cognition.…”

Section: Discussionmentioning

confidence: 99%

Increased anticholinergic medication use in middle‐aged and older autistic adults and its associations with self‐reported memory difficulties and cognitive decline

McQuaid,

Duane,

Ahmed

et al. 2023

Autism Research

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Many commonly used prescription and over‐the‐counter medicines have potent anticholinergic (AC) effects. Among older adults, AC medications are associated with cognitive impairment and risk for cognitive disorders, including Alzheimer's disease. Collectively, the impact of AC medications is known as anticholinergic cognitive burden (ACB). Because of the high rates of co‐occurring medical and psychiatric conditions, autistic adults may have high AC exposure and, thus, may experience elevated ACB. However, no research has characterized AC exposure or examined its associations with cognitive outcomes in autistic adults. Autistic adults (40–83 years) recruited via Simons Powering Autism Research's (SPARK) Research Match service self‐reported their medication use (N = 415) and memory complaints (N = 382) at Time (T)1. At T2, 2 years later, a subset of T1 participants (N = 197) self‐reported on decline in cognition. Medications were coded using two scales of AC potency. A high proportion (48.2%–62.9%, depending upon the AC potency scale) of autistic adults reported taking at least one medication with AC effects, and 20.5% to 26.5% of autistic adults reported clinically‐relevant levels of AC medication (potency ≥3). After controlling for birth‐sex, and age, hierarchical linear regression models showed total ACB scores and AC potency values of ≥3 predicted greater memory complaints. Logistic regression models showed that AC medicines at T1 were associated with self‐reported cognitive decline at follow‐up 2 years later. Understanding AC medications—including potentially earlier AC polypharmacy—and their impacts on cognition (e.g., dementia risk) in autistic adults is warranted.

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Effect of anticholinergic burden on the development of dementia in older adults with subjective cognitive decline

Cited by 9 publications

References 34 publications

Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review

Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review

Comparison of Potentially Inappropriate Medications for People with Dementia at Admission and Discharge during An Unplanned Admission to Hospital: Results from the SMS Dementia Study

Increased anticholinergic medication use in middle‐aged and older autistic adults and its associations with self‐reported memory difficulties and cognitive decline

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