Adverse Effects of Anticholinergic Drugs on Cognition and Mobility: Cutoff for Impairment in a Cross-Sectional Study in Young–Old and Old–Old Adults

Attoh-Mensah, Elpidio; Loggia, Gilles; Schumann-Bard, Pascale; Morello, Rémy; Descatoire, Pablo; Marcelli, Christian; Chavoix, Chantal

doi:10.1007/s40266-019-00743-z

Cited by 20 publications

(26 citation statements)

References 46 publications

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“…This systematic review investigated the association between anticholinergic burden and mobility in older adults. The studies revealed the importance of stratifying the analysis by age, as one study showed for the rst time that "young-old" (54-74yrs) and "old-old" participants (≥75) users of anticholinergic drugs have distinct cognitive pro les [14]. For example, TUG scores were more frequently impaired in non-users of anticholinergic drugs only in the old-old adults and not the young-old adults.…”

Section: Discussionmentioning

confidence: 99%

“…The study participants were mostly living in the community [19,23,25,26], some were outpatients [12,22], whilst others were based in a nursing home [15,18]. The inclusion criteria of other studies were morbidity speci c; People with Alzheimer's [21], Vascular Dementia [20], Hypertension [1], moderate to severe disability [27], as well as those with a history of falls [14].…”

Section: Participant Characteristicsmentioning

confidence: 99%

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The association between anticholinergic burden and mobility: A systematic review and meta-analyses

Phutietsile

Fotaki

Jamieson

et al. 2022

Preprint

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Background: As people age, they accumulate several health conditions, requiring the use of multiple medications (polypharmacy) to treat them. One of the challenges with polypharmacy is the associated increase in anticholinergic exposure to older adults. In addition, several studies suggest an association between anticholinergic burden and declining physical function in older adults.Objective/Purpose: This systematic review aimed to synthesise data from published studies regarding the association between anticholinergic burden and mobility. The studies were critically appraised for the strength of their evidence.Methods: A systematic literature search was conducted across four electronic databases, EMBASE, CINHL, PSYCHINFO and MEDLINE, from inception to December 2021, to identify studies on the association of anticholinergic burden with mobility. The search was performed following a strategy that converted concepts in the PICO elements into search terms, focusing on terms most likely to be found in the title and abstracts of the studies. For observational studies, the risk of bias was assessed using the Newcastle Ottawa Scale, and the Cochrane risk of bias tool was used for randomised trials. For the meta-analyses, we explored the heterogeneity using the Q test and I2 test and the publication bias using the funnel plot and Egger’s regression test. The meta-analyses were performed using Jeffreys’s Amazing Statistics Program (JASP). Results: 16 studies satisfied the inclusion criteria from an initial 372 studies. Fifteen studies identified a significant negative association of anticholinergic burden with mobility measures. One study did not find an association between anticholinergic intervention and mobility measures. Five studies included in the meta-analyses showed that anticholinergic burden significantly decreased walking speed (0.079m/s ±0.035 MD±SE,95% CI: 0.010 to 0.149, p=0.026), whilst a meta-analysis of four studies showed that anticholinergic burden significantly decreased physical function as measured by three variations of the Instrumental Activities of Daily Living (IADL) instrument 0.27±0.12 (SMD±SE,95% CI: 0.03 to 0.52), p=0.027. Egger’s test did not reveal publication bias.Conclusion: There is consensus in published literature suggesting a clear association between anticholinergic burden and mobility. Consideration of cognitive anticholinergic effects may be important in interpreting results regarding the association of anticholinergic burden and mobility as anticholinergic drugs may affect mobility through cognitive effects

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Section: Discussionmentioning

confidence: 99%

Section: Participant Characteristicsmentioning

confidence: 99%

The association between anticholinergic burden and mobility: A systematic review and meta-analyses

Phutietsile

Fotaki

Jamieson

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Polypharmacy was defined as being on 5 or more medications. Medications with anticholinergic activity, which can impact cognition (such as the use of antihistamines, antiparkinson, opiates, antimuscarinic, antipsychotic and antiepileptic drugs) [35] were also determined.…”

Section: Patient and Public Involvementmentioning

confidence: 99%

Relationship between Vitamin C Deficiency and Cognitive Impairment in Older Hospitalised Patients: A Cross-Sectional Study

et al. 2022

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Vitamin C is a powerful antioxidant and facilitates neurotransmission. This study explored association between vitamin C deficiency and cognitive impairment in older hospitalised patients. This prospective study recruited 160 patients ≥ 75 years admitted under a Geriatric Unit in Australia. Cognitive assessment was performed by use of the Mini-Mental-State-Examination (MMSE) and patients with MMSE scores <24 were classified as cognitively-impaired. Fasting plasma vitamin C levels were determined using high-performance-liquid-chromatography. Patients were classified as vitamin C deficient if their levels were below 11 micromol/L. Logistic regression analysis was used to determine whether vitamin C deficiency was associated with cognitive impairment after adjustment for various covariates. The mean (SD) age was 84.4 (6.4) years and 60% were females. A total of 91 (56.9%) were found to have cognitive impairment, while 42 (26.3%) were found to be vitamin C deficient. The mean (SD) MMSE scores were significantly lower among patients who were vitamin C deficient (24.9 (3.3) vs. 23.6 (3.4), p-value = 0.03). Logistic regression analysis suggested that vitamin C deficiency was 2.9-fold more likely to be associated with cognitive impairment after adjustment for covariates (aOR 2.93, 95% CI 1.05–8.19, p-value = 0.031). Vitamin C deficiency is common and is associated with cognitive impairment in older hospitalised patients.

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“…The use of antimuscarinics in high-risk individuals other than elderly subjects should also be avoided. Finally, the clinician should consider reconciling the medications of a given patient to reduce anticholinergic burden (69,75,80). e) Adherence and persistence with antimuscarinics: Typically, adherence in clinical trials is much higher than in real world clinical practice (68).…”

Section: Antimuscarinicsmentioning

confidence: 99%

Current pharmacotherapy of overactive bladder

2021

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Overactive bladder is a symptom complex consisting of bothersome storage urinary symptoms that is highly prevalent among both sexes and has a significant impact on quality of life. Various antimuscarinic agents and the beta-3 agonists mirabegron and vibegron are currently available for the treatment of OAB. Each drug has specific pharmacologic properties, dosing schedule and tolerability profile, making it essential to individualize the medical treatment for the patient's characteristics and expectations. In this manuscript, we review the most important factors involved in the contemporary pharmacological treatment of OAB.

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Adverse Effects of Anticholinergic Drugs on Cognition and Mobility: Cutoff for Impairment in a Cross-Sectional Study in Young–Old and Old–Old Adults

Cited by 20 publications

References 46 publications

The association between anticholinergic burden and mobility: A systematic review and meta-analyses

The association between anticholinergic burden and mobility: A systematic review and meta-analyses

Relationship between Vitamin C Deficiency and Cognitive Impairment in Older Hospitalised Patients: A Cross-Sectional Study

Current pharmacotherapy of overactive bladder

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