A review of published anticholinergic scales and measures and their applicability in database analyses

Lozano‐Ortega, Greta; Johnston, Karissa; Cheung, Antoinette; Wagg, Adrian; Campbell, Noll L.; Dmochowski, Roger R.; Ng, Daniel

doi:10.1016/j.archger.2019.05.010

Cited by 83 publications

(91 citation statements)

References 28 publications

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“…As with the ABS, individual medications may be summed within the Anticholinergic Risk Scale and ACB to provide an overall anticholinergic burden score. A recent review identified the ACB scale to be suited for analysis of administrative data 32 . After reviewing 6 anticholinergic burden scales, we used a combination of the following 2 standard scales: ACB and the newly created ACB score developed in Germany to calculate the individual anticholinergic burden from prescriptions 33 .…”

Section: Methodsmentioning

confidence: 99%

Anticholinergics May Carry Significant Cognitive and Gait Burden in Parkinson's Disease

Rajan

Saini

Verma

et al. 2020

Movement Disord Clin Pract

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Background Background: Anticholinergic drugs are associated with significant cognitive and other adverse events in older adults, including those with Parkinson's disease (PD). Anticholinergic effects are considered lesser in younger individuals and the burden and outcomes in younger patients with PD are unknown. Objectives Objectives: To determine the cumulative anticholinergic burden in a cohort of younger of patients with PD and to correlate the same with cognitive impairment and freezing of gait (FOG). Methods Methods: We conducted a cross-sectional study to identify the cumulative anticholinergic burden from medications prescribed to patients with PD. Two standard scales, the Anticholinergic Cognitive Burden (ACB) scale and the ACB score, were used to calculate the anticholinergic burden from prescriptions. We identified commonly prescribed drugs contributing to anticholinergic effects and correlated the cumulative ACB score with cognitive impairment (Movement Disorder Society-Unified Parkinson's Disease Rating Scale item 1.1) and FOG (Movement Disorder Society-Unified Parkinson's Disease Rating Scale items 2.13 and 3.11). Results Results: We recruited 287 patients with PD (68.9% male) with a mean age of 56.9 AE 11.8 years and a duration of symptoms 6.3 AE 6.9 years. Median ACB score was 4 (range 0-12). A total of 164 (58.4%) patients had total ACB score > 3. ACB score > 3 was independently associated with cognitive impairment (Odds Ratio, 2.55; 95% confidence interval, 1.43-4.53; P < 0.001) and FOG using patient-reported measures (Odds Ratio, 3.192; 95% Confidence Interval, 1.68-6.07; P < 0.001) and objective measures (odds ratio, 2.41; 95% confidence interval, 1.27-4.6, P = 0.007). Conclusion Conclusion: Patients with PD are exposed to significant anticholinergic burden from drugs prescribed for PD and non-PD indications. Higher anticholinergic burden is associated with cognitive impairment and FOG even in younger patients with PD. Anticholinergics are a common class of drugs used to treat the symptoms of Parkinson's disease (PD), particularly tremors. Anticholinergic drugs are often used in the early stages of PD, when symptoms are mild, and more than 50% of prescriptions to patients with PD across healthcare settings contain these drugs. 1 Levodopa in combination with a peripheral decarboxylase inhibitor is the mainstay of treatment in PD, and other medications such as dopamine agonists, monoamine oxidase-B inhibitors, and catechol-O-methyl transferase inhibitors maybe used additionally as monotherapy or add ons. Some of these drugs also have additional anticholinergic effects along with their major effects on dopaminergic neurotransmission. In addition to these, patients with PD may also be prescribed drugs with primary or secondary anticholinergic effects for non-PD indications, such as psychiatric symptoms and other medical comorbidities. 2 Primarily anticholinergic drugs and the secondary anticholinergic properties of drugs prescribed for PD and non-PD indications can contribute to the overall anticho...

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Section: Methodsmentioning

confidence: 99%

Anticholinergics May Carry Significant Cognitive and Gait Burden in Parkinson's Disease

Rajan

Saini

Verma

et al. 2020

Movement Disord Clin Pract

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“…However, it was not included here as it does not consider anticholinergic potency and would therefore likely have similar limitations as those of the cumulative dose measure [17]. Additional details on the characteristics of anticholinergic measures assessed can be found in this published review [18].…”

Section: Methodsmentioning

confidence: 99%

“…Several scales exist for quantifying anticholinergic exposure cross-sectionally; [4, 9–17] however, only two published measures [developed by Gray et al (cumulative dose) and Campbell et al (average daily dose)] allow for the extrapolation of anticholinergic burden scale scores over time [5, 6]. The applicability of anticholinergic scales and measures for use in the United States (US) observational studies was recently reviewed by Lozano-Ortega et al [18] That review concluded that both Gray’s cumulative dose measure, which considers patient-specific dosing [5], and Campbell’s average daily dose measure [6], which considers anticholinergic potency, could be implemented in administrative claims data. However, as both anticholinergic dose and theoretical potency have individually been identified as contributors to anticholinergic burden, a measure that considers both could potentially capture the impact of the interaction between patient-specific dosing and presumed anticholinergic activity.…”

Section: Introductionmentioning

confidence: 99%

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An Evaluation of Longitudinal Measures of Anticholinergic Exposure for Application in Retrospective Administrative Data Analyses

et al. 2019

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IntroductionAs continuous exposure to anticholinergics has been associated with adverse outcomes, accurately measuring exposure is important. However, no gold standard measure is available, and the performance of existing measures has not been compared. Our objective was to compare the properties of the Cumulative Anticholinergic Burden (CAB) measure against two existing measures of anticholinergic exposure and to assess their compatibility for use in observational studies based on claims data.MethodsThe average daily dose, cumulative dose and CAB measures were evaluated on: the applicability for use with anticholinergic burden scales, the ability to consider duration and/or accumulation of exposure, and consideration of anticholinergic dose, potency, and residual effect. To calculate each measure empirically, Truven MarketScan claims data from 2012 to 2015 were analyzed. Cumulative anticholinergic exposure over 1-year post-enrollment was calculated for each measure using Anticholinergic Cognitive Burden scale scores. Median [interquartile range (IQR)] and ranges of measure scores, and Spearman’s correlation coefficients between measures, were estimated. Due to the differing methods of calculation, the absolute values of each score cannot be compared.ResultsThe properties of the different measures varied, with only the CAB considering both dose and theoretical potency. The cohort included 99,742 individuals (mean age = 73.1 years; 54.9% female). Among individuals prescribed anticholinergics (n = 55,969), 1-year median (IQR) scores based on average daily dose, cumulative dose and CAB measures were 0.9 (0.3–1.5), 16.9 (7.3–33.9) and 203 (68–500), respectively. Measures were highly inter-correlated (r2 = 0.74-0.83).ConclusionsConsidering both potency and dose, the CAB may prove a more comprehensive measure of anticholinergic burden; however, additional research is necessary to demonstrate whether it has any association with relevant health-related outcomes.FundingAstellas Pharma Global Development, Inc.Electronic supplementary materialThe online version of this article (10.1007/s12325-019-01035-z) contains supplementary material, which is available to authorized users.

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“…[21] It has been shown to have better consistency in dose-response with adverse clinical outcome compared to the Anticholinergic Risk Scale (ARS) and the Drug Burden Index -Anticholinergic component (DBI-ACh). [22] The ACB is correlates strongly with the Anticholinergic Drug Scale, and both scales have been found to be well-suited for quantification of exposure to medications with anticholinergic properties [23] The list of drugs including in the ACB scale according to severity of anticholinergic effect (1=possible, 2 and 3=definite) are included in Supplementary Table 1. A previous list was used relevant to the period of study, but an updated list was published in 2012 which is available on www.agingbraincare.org.…”

Section: Anticholinergic Burdenmentioning

confidence: 99%

Use of Medications with Anticholinergic Properties and the Long-Term Risk of Hospitalization for Falls and Fractures in the EPIC-Norfolk Longitudinal Cohort Study

Tan

Mat

et al. 2019

Drugs Aging

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A review of published anticholinergic scales and measures and their applicability in database analyses

Cited by 83 publications

References 28 publications

Anticholinergics May Carry Significant Cognitive and Gait Burden in Parkinson's Disease

Anticholinergics May Carry Significant Cognitive and Gait Burden in Parkinson's Disease

An Evaluation of Longitudinal Measures of Anticholinergic Exposure for Application in Retrospective Administrative Data Analyses

Use of Medications with Anticholinergic Properties and the Long-Term Risk of Hospitalization for Falls and Fractures in the EPIC-Norfolk Longitudinal Cohort Study

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