Anticholinergic Medication Burden in Parkinson’s Disease Outpatients

Abstract

Background: Individuals with Parkinson’s disease (PD) may be especially vulnerable to future cognitive decline from anticholinergic medications. Objective: To characterize anticholinergic medication burden, determine the co-occurrence of anticholinergic and cholinesterase inhibitors, and to assess the correlations among anticholinergic burden scales in PD outpatients. Methods: We studied 670 PD outpatients enrolled in a clinic registry between 2012 and 2020. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Drug Burden Index-Anticholinergic component (DBI-Ach). Correlations between scales were assessed with weighted kappa coefficients. Results: Between 31.5 to 46.3% of PD patients were taking medications with anticholinergic properties. Among the scales applied, the ACB produced the highest prevalence of medications with anticholinergic properties (46.3%). Considering only medications with definite anticholinergic activity (scores of 2 or 3 on ACB, ADS, or ARS), the most common anticholinergic drug classes were antiparkinsonian (8.2%), antipsychotic (6.4%), and urological (3.3%) medications. Cholinesterase inhibitors and medications with anticholinergic properties were co-prescribed to 5.4% of the total cohort. The most highly correlated scales were ACB and ADS (κ= 0.71), ACB and ARS (κ= 0.67), and ADS and ARS (κ= 0.55). Conclusion: A high proportion of PD patients (20%) were either taking antiparkinsonian, urological, or antipsychotic anticholinergic medications or were co-prescribed anticholinergic medications and cholinesterase inhibitors. By virtue of its detection of a high prevalence of anticholinergic medication usage and its high correlation with other scales, our data support use of the ACB scale to assess anticholinergic burden in PD patients.

Neuroprotective Effects of Oligosaccharides From Periplaneta Americana on Parkinson’s Disease Models In Vitro and In Vivo

“…As the commonly used medicines, traditional anticholinergic drugs, such as trihexyphenidyl hydrochloride, amantadine, and levodopa preparations, have been found to exert serious side effects. Among them, the discomfort caused by the patient’s gastrointestinal tract is the most common, namely indigestion, vomiting, and constipation ( Sheu et al, 2019 ; Nawaz et al, 2022 ). Until now, none of therapies have been convincingly shown to slow down or prevent the progression of PD.…”

“…Periplaneta Americana ( P. Americana ), commonly known as the cockroach, has been a noted traditional Chinese medicinal material for thousands of years ( Ma et al, 2018 ). Studies showed that the P. Americana , which is widely distributed in tropical areas, contains a variety of small molecule peptides and amino acids, polysaccharides, oligosaccharides, clusterins, pheromones, and other components, which can promote tissue repair, enhance myocardial contractility, protect liver and resist damage, and improve immunity ( Sheu et al, 2019 ; Nawaz et al, 2022 ). According to the results of preliminary research in the laboratory ( Lu et al, 2021 ), researchers verified that the oligosaccharides extracted from the dregs of P. Americana (OPA), which were composed of 83% glucose, 11% xylose and 6% galactose, could effectively improve enteritis of model mice and demonstrated certain antioxidant activity.…”

Prevalence and patterns of the concurrent use of anticholinergics for the motor symptoms of Parkinson’s disease and acetylcholinesterase inhibitors in Parkinson’s disease patients with dementia: a cross-sectional study using Korea National Health Insurance claims data

“…The authors reported that approximately 81.3% of patients with PD receiving ACHEIs had a history of concurrent use of anticholinergics, and 45% were treated with high-potency anticholinergics. Another study with 670 PD outpatients enrolled in a clinic registry in the US between 2012 and 2020, reported that 5.4% of the study cohort were co-prescribed cholinesterase inhibitors and medications with anticholinergic properties [10]. Bayón and Sampedro analysed the use of inappropriate treatments in 500 patients with cognitive decline [11].…”