Anticholinergic Drug Burden in Persons with Dementia Taking a Cholinesterase Inhibitor: The Effect of Multiple Physicians

Reppas‐Rindlisbacher, Christina; Fischer, Hadas D.; Fung, Kinwah; Gill, Sudeep S.; Seitz, Dallas; Tannenbaum, Cara; Austin, Peter C.; Rochon, Paula A.

doi:10.1111/jgs.14034

Cited by 33 publications

(26 citation statements)

References 42 publications

(49 reference statements)

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“…A number of risk factors for cognitive decline had been reported, such as depressed mood, comorbidities, polypharmacy, use of antipsychotics and frailty, and anticholinergic burden remained to be an independent risk for cognitive decline. In the present study, we found CV agents with anticholinergic properties were the most commonly used item among patients with or without using antipsychotics, which was different from other epidemiological studies . The CV agents listed in the ACB scale included atenolol, captopril, digoxin, dipyridamole, furosemide, hydralazine, isosorbide, metoprolol, nifedipine and so on, which could be easily overlooked by clinicians.…”

Section: Discussioncontrasting

confidence: 82%

“…In addition to the aforementioned findings, the present study also explored the impact of anticholinergic activities of non‐antipsychotic medications on short‐term cognitive decline. Antipsychotic drugs, especially resperidone, quetiapine and olanzapine, were the most commonly prescribed drugs in long‐term care facilities . These antipsychotics were well known by their anticholinergic properties, and were believed to contribute the majority of the adverse cognitive effects in anticholinergics .…”

Section: Discussionmentioning

confidence: 99%

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Association between using medications with anticholinergic properties and short‐term cognitive decline among older men: A retrospective cohort study in Taiwan

Wang

Hung

et al. 2017

Geriatrics Gerontology Int

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Aim The use of anticholinergic drugs had been strongly linked to adverse health outcomes among older adults, especially in cognitive impairment or dementia. The present study aimed to evaluate the cognitive decline related to the use of anticholinergic drugs among older men living in the veterans’ homes in Taiwan. Methods This retrospective cohort study was a substudy of The Longitudinal Older Veterans study. A total of 274 residents living in four Taiwan veterans’ homes and receiving two consecutive Mini‐Mental State Examinations within the interval of 6 months from January 2012 to December 2014 were enrolled in the present study. The medication lists for all participants were reviewed by the same physician, and the anticholinergic properties of the individual medications were evaluated by using the Anticholinergic Cognitive Burden scale. Cognitive decline was defined as the decrease of Mini‐Mental State Examinations scores during the study period. Results Overall, 139 persons (50.7%) had exposure to anticholinergic drugs at baseline (designated as AC[+]), and the most frequently used anticholinergic drugs were cardiovascular drugs (48.2%), antipsychotics (21.6%), theophylline (20.1%), antidepressants (12.2%), gastrointestinal drugs (11.5%) and antihistamines (8.6%). After adjusting for covariates, AC(+) participants had a significantly higher risk for short‐term cognitive decline (OR 2.69, 95% CI 1.36–5.31). After excluding 30 participants using antipsychotics, non‐antipsychotics AC(+)participants still had a significantly higher risk for short‐term cognitive decline (OR 2.24, 95% CI 1.26–3.99). Conclusions Exposure to anticholinergic drugs significantly increased the risk for short‐term cognitive decline among older men, and the adverse effects remained similar when antipsychotics were excluded for analysis. A further intervention study is required to evaluate whether reducing anticholinergic burden might improve cognitive function among older adults. Geriatr Gerontol Int 2017: 17 (Suppl. 1): 57–64.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Association between using medications with anticholinergic properties and short‐term cognitive decline among older men: A retrospective cohort study in Taiwan

Wang

Hung

et al. 2017

Geriatrics Gerontology Int

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“…Selection of independent variables was guided by a literature search 8,9,19–28 and the Andersen Behavioral Model for Health Services Utilization (ABM) 29 . The ABM proposes that use of health services, including medications, is influenced by a combination of: predisposing factors, influencing need for healthcare based on their demographics; enabling factors, the environmental factors that facilitate or inhibit access to healthcare; and medical need factors or aspects of the individual’s health perceived by the individual or a medical professional as necessary for seeking healthcare.…”

Section: Methodsmentioning

confidence: 99%

Anticholinergic Prescribing in Medicare Part D Beneficiaries Residing in Nursing Homes: Results from a Retrospective Cross-Sectional Analysis of Medicare Data

et al. 2017

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Background Prescribing of medications with anticholinergic properties in older nursing home residents is relatively common, despite an association with increased risk for falls, delirium and other outcomes. Few studies have investigated what factors influence different levels of prescribing of these agents. Objectives The primary objective was to identify factors associated with low- and high-level anticholinergic burden in nursing home residents. A secondary objective was to examine in detail the contribution of different medications to low versus high burden, to aid in determining drugs to target in interventions. Design Retrospective, cross-sectional analysis. Setting National sample of 2009–2010 Medicare Part A and B claims, Part D prescription drug events, and Minimum Data Set (MDS) v2.0 assessments. Participants The cohort included 4730 Medicare beneficiaries age ≥65 with continuous Medicare Parts A, B, and D enrollment, admitted for non-skilled stays ≥14 days between 01/01/2010–09/30/2010. Measurements Anticholinergic burden was defined using the Anticholinergic Cognitive Burden(ACB) scale. Medication scores were summed at the patient-level and categorized as high (score ≥3), low (score 1–2), or none. Baseline predisposing (age, sex, race/ethnicity), enabling (prior year hospital, emergency department, primary care, specialist visits; region; Medicaid/low-income subsidy), and medical need factors (dementia severity, anti-dementia medication, Charlson co-morbidity index [CCI], select comorbidities) were evaluated for association with anticholinergic burden using multinomial logistic regression. Results Overall, 29.6% had high-level anticholinergic burden, and 35.2% had low-level burden. High-level burden was most often (72%) due to one highly anticholinergic medication rather than cumulative effect. In adjusted analyses, factors associated with increased risk of both low and high anticholinergic burden included: comorbidity, antidementia medication, depression, hypertension, and prior year hospitalization. Older age was associated with decreased odds of high anticholinergic burden. Urinary incontinence and prior year specialist visit were associated with increased odds of high anticholinergic burden. Severe and non-severe dementia were associated with decreased odds of low-level burden, but increased odds of high-level burden. Conclusion Almost two-thirds of nursing home patients have some degree of anticholinergic burden. Several medical need variables are significantly associated with increased risk for low-level and high-level anticholinergic burden. Interventions should be developed to optimize prescribing for residents at increased risk of receiving medications with anticholinergic properties. Future study is needed to evaluate the difference in the risk of adverse outcomes associated with various levels of anticholinergic burden.

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“…4 People with dementia also have high likelihood of comorbidities and associated polypharmacy. 7,8 Previous international studies have shown that prevalence of PIP in people with dementia is between 15% and 64%. 7,8 Previous international studies have shown that prevalence of PIP in people with dementia is between 15% and 64%.…”

Section: Introductionmentioning

confidence: 99%

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

Eshetie

Nguyen

Gillam

et al. 2019

Int J Geriat Psychiatry

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Objective To investigate the prevalence of potentially inappropriate prescribing (PIP) using the Screening Tool of Older Person's Prescriptions (STOPP) criteria in people with dementia compared with people without dementia. Methods A retrospective cohort study was conducted using the Pharmaceutical Benefits Scheme 10% sample of pharmacy claims. People with dementia were defined as those dispensed a medicine for dementia (cholinesterase inhibitors, memantine, or risperidone for behavioural and psychological symptoms of dementia) between 1 January 2005 and 31 December 2015, aged 65 years or older at 1 January 2016 and alive at the end of 2016. An age‐ and gender‐matched comparison cohort of people not dispensed medicines for dementia was identified. PIP prevalence was determined between 1 January 2016 and 31 December 2016. Results In total, 8280 people dispensed medicines for dementia and 41 400 comparisons not dispensed medicines for dementia were included: 63% were female and the median age was 82 years. PIP prevalence was 79% among people with dementia compared with 70% among the comparison group (P < .0001). Use of anticholinergics, long‐term use of high‐dose proton pump inhibitors, and use of benzodiazepines were the most common instances of PIP in people with dementia. After adjustments for age, gender, comorbidity, and number of prescribers, people with dementia were more likely to be exposed to PIP than comparisons (adjusted OR 1.44, 95% CI, 1.35‐1.53, P < .0001). Conclusions PIP was more common in people dispensed medicines for dementia than comparisons. These results highlight the need for effective interventions to optimize prescribing in people with dementia.

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Anticholinergic Drug Burden in Persons with Dementia Taking a Cholinesterase Inhibitor: The Effect of Multiple Physicians

Cited by 33 publications

References 42 publications

Association between using medications with anticholinergic properties and short‐term cognitive decline among older men: A retrospective cohort study in Taiwan

Association between using medications with anticholinergic properties and short‐term cognitive decline among older men: A retrospective cohort study in Taiwan

Anticholinergic Prescribing in Medicare Part D Beneficiaries Residing in Nursing Homes: Results from a Retrospective Cross-Sectional Analysis of Medicare Data

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

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