Anticholinergics May Carry Significant Cognitive and Gait Burden in Parkinson's Disease

Abstract

Background Background: Anticholinergic drugs are associated with significant cognitive and other adverse events in older adults, including those with Parkinson's disease (PD). Anticholinergic effects are considered lesser in younger individuals and the burden and outcomes in younger patients with PD are unknown. Objectives Objectives: To determine the cumulative anticholinergic burden in a cohort of younger of patients with PD and to correlate the same with cognitive impairment and freezing of gait (FOG). Methods Methods: We conducted a cross-sectional study to identify the cumulative anticholinergic burden from medications prescribed to patients with PD. Two standard scales, the Anticholinergic Cognitive Burden (ACB) scale and the ACB score, were used to calculate the anticholinergic burden from prescriptions. We identified commonly prescribed drugs contributing to anticholinergic effects and correlated the cumulative ACB score with cognitive impairment (Movement Disorder Society-Unified Parkinson's Disease Rating Scale item 1.1) and FOG (Movement Disorder Society-Unified Parkinson's Disease Rating Scale items 2.13 and 3.11). Results Results: We recruited 287 patients with PD (68.9% male) with a mean age of 56.9 AE 11.8 years and a duration of symptoms 6.3 AE 6.9 years. Median ACB score was 4 (range 0-12). A total of 164 (58.4%) patients had total ACB score > 3. ACB score > 3 was independently associated with cognitive impairment (Odds Ratio, 2.55; 95% confidence interval, 1.43-4.53; P < 0.001) and FOG using patient-reported measures (Odds Ratio, 3.192; 95% Confidence Interval, 1.68-6.07; P < 0.001) and objective measures (odds ratio, 2.41; 95% confidence interval, 1.27-4.6, P = 0.007). Conclusion Conclusion: Patients with PD are exposed to significant anticholinergic burden from drugs prescribed for PD and non-PD indications. Higher anticholinergic burden is associated with cognitive impairment and FOG even in younger patients with PD. Anticholinergics are a common class of drugs used to treat the symptoms of Parkinson's disease (PD), particularly tremors. Anticholinergic drugs are often used in the early stages of PD, when symptoms are mild, and more than 50% of prescriptions to patients with PD across healthcare settings contain these drugs. 1 Levodopa in combination with a peripheral decarboxylase inhibitor is the mainstay of treatment in PD, and other medications such as dopamine agonists, monoamine oxidase-B inhibitors, and catechol-O-methyl transferase inhibitors maybe used additionally as monotherapy or add ons. Some of these drugs also have additional anticholinergic effects along with their major effects on dopaminergic neurotransmission. In addition to these, patients with PD may also be prescribed drugs with primary or secondary anticholinergic effects for non-PD indications, such as psychiatric symptoms and other medical comorbidities. 2 Primarily anticholinergic drugs and the secondary anticholinergic properties of drugs prescribed for PD and non-PD indications can contribute to the overall anticho...

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