Association between Anticholinergic Medication Use and Risk of Dementia among Patients with Parkinson's Disease

Abstract

Study Objectives To evaluate the association between anticholinergic medication use, categorized by anticholinergic cognitive burden (primary objective) and cumulative dose (secondary objective), and the risk of developing dementia among patients with Parkinson's disease. Design Retrospective cohort study with an active comparator design. Data Source National Health Insurance Research Database in Taiwan (2001–2011). Patients A total of 1232 adults with Parkinson's disease who were diagnosed between 2002 and 2004 and taking at least one antiparkinson medication during this period were included. Of these patients, 694 were exposed to anticholinergic medications categorized as mild (reference group), and 538 were exposed to anticholinergic medications categorized as moderate or severe (exposure group). Measurements and Main Results Exposure to different types of anticholinergic medications was categorized by using the Anticholinergic Cognitive Burden (ACB) scale, and cumulative doses of anticholinergic medications were measured by using the cumulative minimum doses (cMD) method. Associations between anticholinergic medication use and risk of dementia were assessed by multivariable Cox proportional hazards models. The type of anticholinergics used (moderate or severe vs mild ACB) was not significantly associated with an increased risk of developing dementia (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.72–1.27). After adjusting for confounders, a high cumulative dose of anticholinergic drug (> 1095 cumulative minimum doses [cMDs]) was found to be significantly associated with an increased risk of developing dementia when compared with a low cumulative dose of anticholinergic drug (≤ 90 cMDs) (HR 3.06, 95% CI 1.35–6.97). Conclusion Among patients with Parkinson's disease in Taiwan, those with a high cumulative dose of anticholinergics had an increased risk of being diagnosed with dementia. Physicians should consider prescribing the lowest therapeutic dose of anticholinergic medication when making treatment decisions for patients with Parkinson's disease.

Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis

“…Further automated study searches between April 2018 and November 2019 identified eight additional studies meeting our inclusion criteria [48–55]. Two studies focussed on depression [48, 49], and one on Parkinson’s disease [ 50 ], with the others having no specific disease focus. Five studies would be excluded from meta-analysis due to incompatible definitions of anticholinergic exposure, cognition or by patient duplication [48–52].…”

Changes in Prescribing Practices of Dopaminergic Medications in Individuals with Parkinson's Disease by Expert Care Centers from 2010 to 2017: The Parkinson's Foundation Quality Improvement Initiative

“…A study in the United States demonstrated that higher anticholinergic use was associated with an increased risk of fractures, delirium, emergency department visits, and readmissions to the hospital . Furthermore, a recent study demonstrated that PD patients with a high cumulative dose of anticholinergics had an increased risk of being diagnosed with dementia . In addition, a recently published case‐control study demonstrated in a cohort of elderly patients that exposure to several types of strong anticholinergic drugs was associated with an increased risk of dementia .…”

“…12 Furthermore, a recent study demonstrated that PD patients with a high cumulative dose of anticholinergics had an increased risk of being diagnosed with dementia. 11 In addition, a recently published case-control study demonstrated in a cohort of elderly patients that exposure to several types of strong anticholinergic drugs was associated with an increased risk of dementia. 13 This further suggests that providers should be cautious about anticholinergic drug usage in the PD patient population.…”

“…Although the most recent study did not demonstrate disease‐modifying effect of the earlier initiation of levodopa, there was also no deleterious effect . Furthermore, recent work has demonstrated risks with the use of anticholinergic medications …”

“…10 Furthermore, recent work has demonstrated risks with the use of anticholinergic medications. [11][12][13][14] Despite a large number of data on the efficacy of various pharmacological interventions in PD derived from well-designed controlled studies, there is still a paucity of information on the real-life use of various classes of PD therapeutics. Using the Parkinson's Foundation Quality Improvement Initiative registry collected at participating expert care centers, we analyzed the recent changes in the prescribing practices for the motor symptoms of PD as well as the present-day prescribing landscape.…”