Anticholinergic Exposure During Rehabilitation: Cognitive and Physical Function Outcomes in Patients with Delirium Superimposed on Dementia

Abstract

Objectives We examined the association between anticholinergic medication exposure and subsequent cognitive and physical function in patients with delirium superimposed on dementia during rehabilitation. We also examined length of stay and discharge disposition by anticholinergic medication exposure. Design In this secondary analysis we used control group data from an ongoing randomized clinical trial. Setting/Participants Participants with delirium and dementia were enrolled at admission to post-acute care. These 99 participants had a mean age of 86.11 (± 6.83) years; 67.6% were female; 98% were Caucasian; and 33% were positive for at least one APOE e4 allele. Measures We obtained daily measures of cognitive and physical function using: Digit Span; memory, orientation and attention items from the Montreal Cognitive Assessment; CLOX; Confusion Assessment Method; and Barthel Index. Anticholinergic medication exposure was measured weekly using the Anticholinergic Cognitive Burden Scale. Results Using multilevel models for time we found that greater use of clinically relevant anticholinergic medications in the previous week reduced cognitive and physical function, as measured by Digit Span Backwards and the Barthel Index, in the current week. There was no effect of anticholinergic medication use on delirium severity, and APOE status did not moderate any outcomes. Greater use of clinically relevant anticholinergic medications was related to longer length of stay but not discharge disposition. Conclusion For vulnerable older adults, anticholinergic exposure represents a potentially modifiable risk factor for poor attention, working memory, physical function and greater length of stay during rehabilitation.

Risk Factors and Outcomes of Delirium in Older Patients Admitted to Postacute Care with and without Dementia

“…Dementia and age are widely recognized risk factors for delirium in older hospitalized patients, and our findings confirm previous results in other settings [13, 19, 27]. On the other hand, although polypharmacy in older hospitalized patients is associated with delirium in many studies [10, 28, 29], our study did not confirm this association. This could be consistent with data by Moorey et al [30], showing that the number of prescribed drugs inversely correlated with age.…”

Shared biological pathways for frailty and cognitive impairment: A systematic review

“…An interaction was found between ApoE4 carriers and anticholinergic medications with users having the lowest cognitive scores. Irrespective of ApoE4 status, drugs with high anticholinergic properties were associated with cognitive and physical decline (Jamsen et al, 2016; Kolanowski et al, 2015; Lanctot et al, 2014; Risacher et al, 2016; Uusvaara et al, 2009). Methods for measuring medication burden varied significantly between studies making it difficult compare study results.…”

Anticholinergic drug exposure is associated with delirium and postdischarge institutionalization in acutely ill hospitalized older patients

“…To the best of our knowledge, no previous studies investigated the possible association between anticholinergic drug use and clinical outcomes in acutely ill hospitalized older patients with delirium. Recently, Kolanowski et al (2015) found that the use of anticholinergic drugs according to the ACB was associated with prolonged LOS and reduced physical function, but not with discharge disposition in older persons with delirium who resided in a postacute care facility. In contrast to our study, their sample size was relatively small, all participants had dementia, were not acutely ill, and in the vast majority delirium was resolving.…”