Anticholinergic Activity of 107 Medications Commonly Used by Older Adults

Chew, Marci L.; Mulsant, Benoit H.; Pollock, Bruce G.; Lehman, Mark E.; Greenspan, Andrew; Mahmoud, Ramy; Kirshner, Margaret A.; Sorisio, Denise; Bies, Robert R.; Gharabawi, Georges M.

doi:10.1111/j.1532-5415.2008.01737.x

Cited by 417 publications

(322 citation statements)

References 36 publications

(118 reference statements)

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“…1 The agingrelated decline of acetylcholine production may increase the vulnerability of older adults to anticholinergic adverse effects, 2,3 such as blurred vision, urinary retention, tachycardia, drowsiness, and cognitive impairments. 4 The blurred vision and dizziness caused by exposure to anticholinergic agents may further result in falls and associated adverse events.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes

et al. 2017

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PURPOSE No consensus has been reached regarding which anticholinergic scoring system works most effectively in clinical settings. The aim of this populationbased cohort study was to examine the association between anticholinergic medication burden, as defined by different scales, and adverse clinical outcomes among older adults.METHODS From Taiwan's Longitudinal Health Insurance Database, we retrieved data on monthly anticholinergic drug use measured by the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden Scale (ACB), and the Drug Burden Index -Anticholinergic component (DBI-Ach) for 116,043 people aged 65 years and older during a 10-year follow-up. For all 3 scales, a higher score indicates greater anticholinergic burden. We used generalized estimating equations to examine the association between anticholinergic burden (ARS and ACB: grouped from 0 to ≥4; DBI-Ach: grouped as 0, 0-0.5, and 0.5-1) and adverse outcomes, and stratified individuals by age-group (aged 65-74, 75-84, and ≥85 years). RESULTSCompared with the ARS and DBI-Ach, the ACB showed the strongest, most consistent dose-response relationships with risks of all 4 adverse outcomes, particularly in people aged 65 to 84 years. For example, among those 65 to 74 years old, going from an ACB score of 1 to a score of 4 or greater, individuals' adjusted odds ratio increased from 1.41 to 2.25 for emergency department visits; from 1.32 to 1.92 for all-cause hospitalizations; from 1.10 to 1.71 for fracturespecific hospitalizations; and from 3.13 to 10.01 for incident dementia.CONCLUSIONS Compared with the 2 other scales studied, the ACB shows good dose-response relationships between anticholinergic burden and a variety of adverse outcomes in older adults. For primary care and geriatrics clinicians, the ACB may be a helpful tool for identifying high-risk populations for interventions. Ann Fam Med 2017;15:561-569. https://doi.org/10.1370/afm.2131. INTRODUCTIONM edications with anticholinergic properties are used for a variety of diseases and constitute 30% to 50% of all medications com monly prescribed to older adults. 1 The agingrelated decline of acetylcholine production may increase the vulnerability of older adults to anticholinergic adverse effects, 2,3 such as blurred vision, urinary retention, tachycardia, drowsiness, and cognitive impairments. 4 The blurred vision and dizziness caused by exposure to anticholinergic agents may further result in falls and associated adverse events. 57 The cognitive impairment associated with exposure to these medications may lead to chronic cogni tive deficits such as dementia. 4,8 The cumulative effect of multiple anti cholinergic agents, the socalled anticholinergic burden, has been used as an indicator for suboptimal prescribing in older adults. 9 In recent years, several scoring systems have been developed to quantify anticholinergic burden, such as the Anticholinergic Risk Scale (ARS), 10 562These scales differ considerably in how they were developed, in their method of measuring antich...

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Section: Introductionmentioning

confidence: 99%

“…9 In recent years, several scoring systems have been developed to quantify anticholinergic burden, such as the Anticholinergic Risk Scale (ARS), 10 the Anticholiner gic Cognitive Burden Scale (ACB), 8 and the Drug Burden Index Anticho linergic component (DBIAch). 11 Wen-Han Hsu, MS 1 Yu-Wen Wen, PhD 2 Liang-Kung Chen, MD, PhD 3,4,5 …”

Section: Introductionmentioning

confidence: 99%

Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes

et al. 2017

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“…Participants were followed longitudinally every 18 months for assessment of clinical, medication and neuropsychological measures. Anticholinergic medications were defined as those included on a list developed by Chew and colleagues, which is based on serum anticholinergic activity [Chew et al 2008]. Anticholinergic medications were included if reported prior to the interview that triggered the dementia diagnosis.…”

Section: Data Synthesismentioning

confidence: 99%

Anticholinergic medication use and dementia: latest evidence and clinical implications

Gray

Hanlon

2016

Therapeutic Advances in Drug Safety

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Use of medications with anticholinergic activity is widespread in older adults. Several studies have highlighted that anticholinergic use may be associated with an increased risk of dementia. The objective of this narrative review is to describe and evaluate studies of anticholinergic medication use and dementia and provide practical suggestions for avoiding use of these medications in older adults. A comprehensive review of the literature, citations from recent reviews and the author's personal files was conducted. Four studies were found that evaluated anticholinergic use and dementia as the primary outcome. Three studies focused on overall anticholinergic medication use and reported a statistically significantly increased risk of Alzheimer's disease or dementia. In one study, dementia risk was primarily found with higher cumulative doses; people using anticholinergic medications at the minimum effective dose recommended for older adults for at least 3 years were at highest risk. In contrast, a study conducted in nursing-home residents with depression did not find that paroxetine [a highly anticholinergic selective serotonin reuptake inhibitor antidepressant, (SSRI)] increased risk for dementia compared with other SSRIs (without anticholinergic activity). Further study is needed to understand the mechanism by which anticholinergic medications may increase risk. In conclusion, there is evidence from three observational studies suggesting that anticholinergic medications may increase dementia risk. Given this potential risk and the myriad of other well-known adverse effects (i.e. constipation, blurred vision, urinary retention, and delirium) associated with anticholinergic medications, it is prudent for prescribers and older adults to minimize use of these medications and consider alternatives when possible.

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“…Reasonable secondline antidepressant choices include fluoxetine, mirtazapine, or nefazodone. Mirtazapine can cause mild anticholinergic effects [102] and sedation [103], effects that could aggravate memory problems. Nefazodone can cause serious hepatotoxicity [104], probably via inhibition of hepatocyte mitochondria [105], and alternatives should be carefully considered before it is used.…”

Section: Pharmacotherapy For Ptsd: Considerations For Comorbid Tbimentioning

confidence: 99%

Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury

Capehart¹,

Bass²

2012

JRRD

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Anticholinergic Activity of 107 Medications Commonly Used by Older Adults

Cited by 417 publications

References 36 publications

Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes

Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes

Anticholinergic medication use and dementia: latest evidence and clinical implications

Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury

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