Anticholinergic drug use and risk of mortality for people with dementia in Northern Ireland

Abstract

Objective: Anticholinergic burden refers to the cumulative effect of medications which contain anticholinergic properties. We assessed how anticholinergic burden and different types of anticholinergic medications influence mortality rates among people with dementia in Northern Ireland. Our secondary aim was to determine what demographic characteristics predict the anticholinergic burden of people with dementia. Methods: Data were extracted from the Enhanced Prescribing database for 25,418 people who were prescribed at least one dementia management medication between 2010 and 2016. Information was also extracted on the number of times each available anticholinergic drug was prescribed between 2010 and 2016, allowing the calculation of an overall anticholinergic burden. Cox proportional hazard models were used to determine how anticholinergic burden influenced mortality whilst multilevel model regression determined what demographic characteristics influence overall anticholinergic burden. Results: Of the 25,418 people with dementia, only 15% (n ¼ 3880) had no anticholinergic burden. Diazepam (42%) and risperidone (18%) were the two most commonly prescribed drugs. Unadjusted Cox proportional hazard models indicated that higher anticholinergic burden was associated with significantly higher mortality rates in comparison to people with dementia who had no anticholinergic burden (HR ¼ 1.59: 95% CI ¼ 1.07-2.36). In particular, urological (HR ¼ 1.20: 95% CI ¼ 1.05-1.38) and respiratory (HR ¼ 1.17: 95% CI ¼ 1.08-1.27) drugs significantly increased mortality rates. People with dementia living in areas with low levels of deprivation had significantly lower anticholinergic burden (HR=-.39: 95% CI=-.47:-30). Conclusions: Reducing anticholinergic burden is essential for people with dementia. Further research should address the unfavourable prognosis of people living with dementia in highly deprived areas.

A systematic review of interventions to reduce anticholinergic burden in older people with dementia in primary care

“…No studies were found to be eligible for inclusion in this systematic review – it is therefore an ‘empty review’. This result is unexpected given that first, several studies have previously reported the risks of anticholinergic drug use and high ACB in PwD 11,29,32 and second, because evidence‐based clinical guidance has emphasised the need for high‐quality, clinical trials to evaluate interventions to reduce ACB among PwD 14 . Despite this being an empty review, we consider the findings to be important, as they highlight major gaps in the current evidence‐base and provide some indication as to the direction future research should take to guide clinical practice.…”

CRIDECO Anticholinergic Load Scale: An Updated Anticholinergic Burden Scale. Comparison with the ACB Scale in Spanish Individuals with Subjective Memory Complaints

“…Similarly, there is a clear link between anticholinergic load and reduced cognitive performance [16][17][18]. Not only do these drugs have an impact on clinical entities such as CI, but they have also been linked to increased risk of falls [7] and mortality [24,25]. Furthermore, concomitant use of several medications with anticholinergic action will further increase the likelihood of adverse events [20].…”

“…Given that most of the drugs currently approved for the symptomatic treatment of Alzheimer's disease are aimed at restoring neuronal cholinergic activity [70], it would be contradictory to prescribe drugs whose pharmacological effect blocks this activity. Furthermore, the use of anticholinergic drugs in patients with dementia has been associated with increased mortality [25]. Therefore, in elderly patients, especially in patients with dementia [71] but also in individuals at risk such as those with subjective memory complaints [32], due to increased susceptibility to anticholinergic effects, the use of these drugs should be carefully evaluated.…”

“…Numerous studies associate the use of anticholinergic drugs with CI [16][17][18][19], and several longitudinal studies even consider the use of these drugs as a risk factor for dementia [20][21][22][23]. In addition, the use of these drugs has been linked to higher mortality [24,25] and increased risk of hospitalizations [26].…”

Centrally-acting anticholinergic drugs– associations with mortality, hospitalisation and cognitive decline following dementia diagnosis in people receiving antidepressant and antipsychotic drugs

“…In summary, no evidence for this was found, with all associations either null or in the opposite direction to that anticipated. Other studies have found an increased risk of mortality in people with dementia taking anticholinergic drugs (McMichael et al, 2020, Tan et al, 2018. However, these studies were not restricted to specific classes of drugs such as antidepressants and antipsychotics.…”