Methods for Assessing Drug-Related Anticholinergic Activity

Abstract

The geriatric population is a large consumer of both prescription and over-the-counter drugs. Positive outcomes from drugs depend on the delicate interplay between therapeutic and adverse effects. This relationship becomes tortuous with simultaneous administration of several drugs. Numerous concomitant drug therapies may be essential for providing quality patient care but may also increase the possibility of an adverse drug event. Increasing sensitivity to drug effects in the geriatric population also creates concern over adverse effects. Drugs that possess anticholinergic properties are especially worrisome, as these properties may manifest as hazardous physiologic and psychological adverse drug events. Consequently, clinicians strive to minimize total drug exposure to agents possessing anticholinergic properties in elderly patients. A review of the literature revealed four methods that might help clinicians systematically reduce or eliminate potentially offending anticholinergic drugs. Each of the four has merits and limitations, with no ideal evidence-based approach used. Three of the four methods described have research utility; however, only one of the methods is clinically useful.

Effect of polypharmacy, potentially inappropriate medications and anticholinergic burden on clinical outcomes: a retrospective cohort study

“…With the expected increase in multi morbidity and associated high consumption of drugs among older adults, understanding the quality of drug use for this population is essen tial. Although several indicators have been developed to evaluate the quality of pharmaco therapy in older adults, such as polypharmacy, 1 potentially inappropriate medications 2,3 and anticholinergic burden, 4 several questions remain as to their utility in clinical practice.…”

DEL-FINE: a new tool for assessing the delirogenic properties of drugs of relevance for European pharmacotherapy

“…With a group of European experts it was possible to identify drugs with delirogenic properties relevant to European pharmacotherapy and compose a list with a score on their delirogenic strength. Combining anticholinergic drug lists with clinical judgement is considered to be the only useful method for routine practice according to an analysis by Rudd et al [27]. As using a Delphi method allows individual judgements to be collated, combined, quantified and summarized in a structured way and it is particularly suitable for the aim of creating a list that takes both the pre- Additional comments by experts to drugs with DEL-FINE score 1: a High dose is associated with a higher risk of delirium.…”

Biomarkers of delirium: Well evidenced or not?

“…21,22 The mixed results might be derived from the unproven and questionable hypothesis that peripheral serum assay of SAA also reflects the central anticholinergic load. 23,24 The development of muscarinic subtype specific assays is an exciting innovation which may help clarify the situation. 25 These assays use recombination human muscarinic specific for the five subtypes of acetylcholine, with subtype one postulated as cognition-related.…”