Anticholinergic drugs and functional, cognitive impairment and behavioral disturbances in patients from a memory clinic with subjective cognitive decline or neurocognitive disorders

Abstract

BackgroundDrugs with anticholinergic properties may be associated with various adverse clinical effects. The relationship between the anticholinergic (AC) burden and functional, global cognitive performance and behavior disturbances was assessed among elderly patients.MethodsA cross-sectional study was conducted between January 2012 and June 2014 in a memory clinic among outpatients living at home and with subjective cognitive decline (SCD) or neurocognitive disorders (NCD). The AC burden was measured using the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden (ACB), Chew’s score, Han’s score, and the number of drugs with AC activity. Functional, cognitive performance and behavior disturbances were assessed using the Instrumental Activities of Daily Living (IADL) scale (IADL), the Mini Mental State Examination (MMSE), and the Neuropsychiatric Inventory (NPI).ResultsAmong 473 included patients, 46.3% were at major NCD. Patients took on average 5.3 ± 2.6 drugs. MMSE was lower when Han’s score (p = 0.04) and number of AC drugs were higher (p < 0.001). IADL was lower when AC burden was higher, whatever the AC measurement. NPI was higher when ACB, Han’s score, and number of AC drugs were higher. After adjustment, all AC scores remained associated with IADL, while Han’s score and number of drugs with AC remained associated with the MMSE.ConclusionsIn patients with SCD or NCD, AC burden is associated with lower functional score, whereas the cross-sectional association between AC burden and cognitive performance or behavioral disturbance varies according to AC scores. Particular attention should be paid when prescribing drugs with AC properties, especially among patients with memory complaints.

Anticholinergic burden in the Japanese elderly population: Use of antimuscarinic medications for overactive bladder patients

“…This finding was due to the lower number of ACs that are listed in the ARS and Beers criteria. Regardless of the scale used, lower proportions of patients received an AC in this study versus previous investigations, where prevalences of between 17.1% and 48.4% have been noted . This finding is predominately due to the different patient groups and settings involved in the studies.…”

“…Regardless of the scale used, lower proportions of patients received an AC in this study versus previous investigations, where prevalences of between 17.1% and 48.4% have been noted. [12][13][14] This finding is predominately due to the different patient groups and settings involved in the studies. For example, the present investigation only included reimbursed medications, whereas one of the earlier studies also included over-the-counter drugs.…”

“…Only strong ACs are listed as potentially inappropriate medications in the Beers criteria. Investigations from the primary, secondary and community settings in the USA, UK and France have estimated that between 17.1% and 48.4% of elderly patients receive at least one AC listed in these scales …”

“…Investigations from the primary, secondary and community settings in the USA, UK and France have estimated that between 17.1% and 48.4% of elderly patients receive at least one AC listed in these scales. [12][13][14] A number of AM medications, which show AC properties, have been the mainstay of pharmacotherapy approaches for treating patients with OAB symptoms. 8,15 As the prevalence of OAB increases with age, 16 and older age is associated with polypharmacy, 17 elderly individuals with OAB might experience a higher AC burden.…”

Use of Anticholinergic Drugs and its Relationship With Psychological Well-Being and Mortality in Long-Term Care Facilities in Helsinki

“…2,3 However, they are used for a large number of conditions, mainly to manage symptoms. 4 The prevalence of anticholinergic drug use in nursing home populations varies between 10.5% and 77% depending on the various definitions and scales used for DAPs as well as the different populations. 5,6,7 Anticholinergic drugs are considered to be potentially harmful because of adverse effects on both the peripheral and central nervous systems.…”