Measuring anticholinergic exposure in patients with dementia: A comparative study of nine anticholinergic risk scales

Turró‐Garriga, Oriol; Calvó-Perxas, Laia; Vilalta-Franch, Joan; Blanco-Silvente, Lídia; Castells, Xavier; Capellà, Dolors; Garré-Olmo, Josep

doi:10.1002/gps.4844

Cited by 17 publications

(15 citation statements)

References 42 publications

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“…In the identification of anticholinergic prescriptions prior to fracture, the greatest consistency was found between the ADS and ACB scales (high: 71%), which was also evident in three other studies but in different clinical contexts (62% and 65% in patients with general illness in the US and Australia, respectively, and 62% in patients with dementia in Spain) [19,20,22]. The lowest consistency was observed between the ADS and ARS scales (moderate: 48%), differing from that reported in the other studies, where the poorest agreement was observed between the ACB and ARS scales (20%, 24% and 43%) [19,20,22]. In those studies, the consistency between ADS and ARS was 26% [19], 31% [22] and 53% [20].…”

Section: Discussionsupporting

confidence: 58%

“…However, there is considerable variation among the anticholinergic burden scales, especially in terms of antimuscarinic potency and the number of drugs considered in each instrument [16,17], and there is no current consensus on which scale is optimal [18]. There are few studies that have compared the agreement between anticholinergic burden scales, which have shown in several clinical contexts generally low or intermediate consistencies [19][20][21][22]; moreover, it is unknown which scale identifies the highest proportion of anticholinergic drugs in patients with fractures and the variability or agreement between the instruments is unknown, especially since some of the drugs considered in the risk scales are not available in all countries. Therefore, the aim of this study was to identify the degree of agreement between the anticholinergic burden scales in patients diagnosed with fracture in Colombia.…”

Section: Introductionmentioning

confidence: 99%

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Consistency between anticholinergic burden scales in the elderly with fractures

et al. 2020

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Objective Falls and bone fractures are important causes of morbidity and mortality in the elderly. The objective of this study was to identify the degree of consistency between the anticholinergic scales used for patients diagnosed with fractures. Methods This was an analytical agreement study conducted in patients diagnosed with vertebral and nonvertebral fractures in Colombia. The quadratic-weighted kappa coefficient was used to identify the consistency between the Anticholinergic Drug Scale-ADS, Anticholinergic Cognitive Burden Scale-ACB and Anticholinergic Risk Scale-ARS in assessing the prescriptions of fracture patients during the month prior to the fracture, during their stay as an inpatient and at discharge, according to Landis criteria. Results 220 patients with fractures were included, with a mean age of 75.3±10.3 years, and 68.2% were women. The ACB scale identified the highest anticholinergic burden (26.8%) in prescriptions made the month before the fracture, and the highest agreement was between ACB and ADS (0.717); during hospitalization and at discharge, the cholinergic antagonists were best identified with ADS (77.7% and 72.1%, respectively), with the best agreement between ACB and ARS (0.613 and 0.568, respectively). The prescription of tramadol was found in 64.1% of hospitalized patients and in 61.4% of patients at the time of discharge. Conclusions The scales evaluated show marked discrepancies between them, with highly variable frequencies of anticholinergic drugs identified at the different prescription times, and with low

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Section: Discussionsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Consistency between anticholinergic burden scales in the elderly with fractures

et al. 2020

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Section: Discussionmentioning

confidence: 99%

“…There are few studies that have compared the agreement between anticholinergic burden scales . Oriol et al ., in patients with a diagnosis of dementia, compared the different anticholinergic load scales and found that the Anticholinergic Cognitive Burden Scale identified the highest proportion of anticholinergic drugs among the most validated instruments …”

Section: Discussionmentioning

confidence: 99%

“…The anticholinergic burden has become an indicator used to evaluate the quality of prescriptions among geriatric patients, and its prevalence of exposure varies widely according to where the patient lives (in the community, nursing home or hospitalized) . Thus, the anticholinergic exposure in outpatients with Alzheimer's disease can be 30% or as high as 73% in patients in nursing homes …”

Section: Introductionmentioning

confidence: 99%

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Potentially inappropriate prescriptions of anticholinergics drugs in Alzheimer's disease patients

Valladales‐Restrepo

Duran-Lengua

Machado‐Alba

2019

Geriatrics Gerontology Int

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Aim: Alzheimer's disease is a common cause of dementia, and is usually treated with medications that elevate acetylcholine levels. The objective of the present study was to identify drugs with anticholinergic properties prescribed to patients diagnosed with Alzheimer's disease in Colombia. Methods:A cross-sectional study was carried out in outpatients diagnosed with Alzheimer's disease who were identified from a population database from Colombia, and had been treated with cholinesterase inhibitors and glutamate N-methyl-D-aspartate receptor antagonists. The anticholinergic burden was evaluated using the Anticholinergic Cognitive Burden scale, and patients were classified on a scale of 0-3 points according to anticholinergic potential, and were grouped into those with mild-to-moderate (1-2 points) or high (≥3 points) anticholinergic load.Results: The study included 4134 Alzheimer's disease patients. The mean age was 81.50 AE 8.16 years, and 67.8% were women. At least 22.9% of patients took anticholinergic drugs. Of these, the most frequently prescribed medication was quetiapine (8.6%). Age >85 years was associated with a high risk of having an anticholinergic burden ≥3 points (OR 2.19,. Potential interactions between cholinesterase inhibitors and anticholinergic drugs were identified in 7.8% of patients. Conclusions:The majority of patients who were prescribed anticholinergic drugs were older women, had a significant total anticholinergic burden and had frequent pharmacological interactions with cholinesterase inhibitors. The use of anticholinergics reduces the clinical effectiveness of antidementia drugs and increases the risk of adverse reactions. Geriatr Gerontol Int 2019; 19: 913-917.

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A systematic review of interventions to reduce anticholinergic burden in older people with dementia in primary care

Shawaqfeh¹,

Hughes²,

Barry³

2022

Int J Geriat Psychiatry

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Objective: This systematic review aimed to assess the types and effectiveness of interventions that sought to reduce anticholinergic burden (ACB) in people with dementia (PwD) in primary care. Methods:One trial registry and eight electronic databases were systematically searched to identify eligible English language studies from inception until December 2021. To be eligible for inclusion, studies had to be randomised controlled trials (RCTs) or non-randomised studies (NRS), including controlled before-and-after studies and interrupted time-series studies, of interventions to reduce ACB in PwD aged ≥65 years (either community-dwelling or care home residents). All outcomes were to be considered. Quality was to be assessed using the Cochrane Risk of Bias tool for RCTs and ROBINS-I tool for NRS. If data could not be pooled for meta-analysis, a narrative synthesis was to be conducted. Results:In total, 1880 records were found, with 1594 records remaining after removal of duplicates. Following title/abstract screening, 13 full-text articles were assessed for eligibility. None of these studies met the inclusion criteria for this review. Reasons for exclusion were incorrect study design, ineligible study population, lack of focus on reducing ACB, and studies conducted outside the primary care setting. Conclusions: This 'empty' systematic review highlights the lack of interventions to reduce ACB in PwD within primary care, despite this being highlighted as a priority area for research in recent clinical guidance. Future research should focus on development and testing of interventions to reduce ACB in this patient population through high-quality clinical trials.

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Measuring anticholinergic exposure in patients with dementia: A comparative study of nine anticholinergic risk scales

Abstract: There is a large difference in outcomes among the 9 anticholinergic risk scales. Clinicians and researchers should be aware of these differences when using these instruments in patients with dementia.

Cited by 17 publications

References 42 publications

Consistency between anticholinergic burden scales in the elderly with fractures

Consistency between anticholinergic burden scales in the elderly with fractures

Potentially inappropriate prescriptions of anticholinergics drugs in Alzheimer's disease patients

A systematic review of interventions to reduce anticholinergic burden in older people with dementia in primary care

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