Association of Anticholinergic Burden with Cognitive and Functional Status in a Cohort of Hospitalized Elderly: Comparison of the Anticholinergic Cognitive Burden Scale and Anticholinergic Risk Scale

Pasina, Luca; Djade, Codjo D.; Lucca, Ugo; Nobili, Alessandro; Tettamanti, Mauro; Franchi, Carlotta; Salerno, Francesco; Corrao, Salvatore; Marengoni, Alessandra; Iorio, Alfonso; Marcucci, Maura; Violi, Francesco; Mannucci, Pier Mannuccio

doi:10.1007/s40266-012-0044-x

Cited by 151 publications

(144 citation statements)

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“…First, by using a nationwide cohort of older adults with fairly long followup, our study allows headtohead comparisons of longitudinal anticholiner gic burden derived from the ARS, ACB, and DBIAch scales and associated clinical outcomes, which have not been previously reported in the literature. Some other studies have tried to compare the ARS and ACB, but were limited by their small sample sizes 15,28 and a 1time crosssectional study design. 17 Second, our study provides important insights by linking anticho linergic burden to 4 key clinical outcomes, whereas most existing studies have examined only the discrep ancies between scales.…”

Section: Discussionmentioning

confidence: 99%

“…11 To date, no consensus has been reached regarding which scoring system is most useful in clinical settings. Moreover, existing studies of the various scoring sys tems have a variety of limitations: evaluation of only a single system, 1214 application of different cutoff values for anticholinergic burden between scoring systems, small sample sizes, 15,16 crosssectional designs, 15,16 and short followup periods 17 (≤1 year). All of these limita tions preclude a clear answer to this clinical question.…”

Section: Fei-yuan Hsiao Phdmentioning

confidence: 99%

“…These findings are also in line with those of several previous studies. 13,15,32,35 Primary care and geriatrics clinicians should pay special attention to these medications.Unlike the ACB score, the ARS score showed a doseresponse relationship only with regard to fracturespecific hospitalizations, exhibiting a Ushaped relationship with the other adverse outcomes studied. In particular, we found that the ARS score had a Ushaped relationship with risk of incident dementia, as Pasina et al 15 have likewise reported.…”

mentioning

confidence: 99%

“…These findings are also in line with those of several previous studies. 13,15,32,35 Primary care and geriatrics clinicians should pay special attention to these medications.…”

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confidence: 99%

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Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes

et al. 2017

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PURPOSE No consensus has been reached regarding which anticholinergic scoring system works most effectively in clinical settings. The aim of this populationbased cohort study was to examine the association between anticholinergic medication burden, as defined by different scales, and adverse clinical outcomes among older adults.METHODS From Taiwan's Longitudinal Health Insurance Database, we retrieved data on monthly anticholinergic drug use measured by the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden Scale (ACB), and the Drug Burden Index -Anticholinergic component (DBI-Ach) for 116,043 people aged 65 years and older during a 10-year follow-up. For all 3 scales, a higher score indicates greater anticholinergic burden. We used generalized estimating equations to examine the association between anticholinergic burden (ARS and ACB: grouped from 0 to ≥4; DBI-Ach: grouped as 0, 0-0.5, and 0.5-1) and adverse outcomes, and stratified individuals by age-group (aged 65-74, 75-84, and ≥85 years). RESULTSCompared with the ARS and DBI-Ach, the ACB showed the strongest, most consistent dose-response relationships with risks of all 4 adverse outcomes, particularly in people aged 65 to 84 years. For example, among those 65 to 74 years old, going from an ACB score of 1 to a score of 4 or greater, individuals' adjusted odds ratio increased from 1.41 to 2.25 for emergency department visits; from 1.32 to 1.92 for all-cause hospitalizations; from 1.10 to 1.71 for fracturespecific hospitalizations; and from 3.13 to 10.01 for incident dementia.CONCLUSIONS Compared with the 2 other scales studied, the ACB shows good dose-response relationships between anticholinergic burden and a variety of adverse outcomes in older adults. For primary care and geriatrics clinicians, the ACB may be a helpful tool for identifying high-risk populations for interventions. Ann Fam Med 2017;15:561-569. https://doi.org/10.1370/afm.2131. INTRODUCTIONM edications with anticholinergic properties are used for a variety of diseases and constitute 30% to 50% of all medications com monly prescribed to older adults. 1 The agingrelated decline of acetylcholine production may increase the vulnerability of older adults to anticholinergic adverse effects, 2,3 such as blurred vision, urinary retention, tachycardia, drowsiness, and cognitive impairments. 4 The blurred vision and dizziness caused by exposure to anticholinergic agents may further result in falls and associated adverse events. 57 The cognitive impairment associated with exposure to these medications may lead to chronic cogni tive deficits such as dementia. 4,8 The cumulative effect of multiple anti cholinergic agents, the socalled anticholinergic burden, has been used as an indicator for suboptimal prescribing in older adults. 9 In recent years, several scoring systems have been developed to quantify anticholinergic burden, such as the Anticholinergic Risk Scale (ARS), 10 562These scales differ considerably in how they were developed, in their method of measuring antich...

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Section: Discussionmentioning

confidence: 99%

Section: Fei-yuan Hsiao Phdmentioning

confidence: 99%

mentioning

confidence: 99%

“…These findings are also in line with those of several previous studies. 13,15,32,35 Primary care and geriatrics clinicians should pay special attention to these medications.…”

mentioning

confidence: 99%

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Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes

et al. 2017

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“…Ultimately, the risk of falls increases and function is impaired. [5][6][7][8][9][10][11] This problem is especially important in older people because there is an age-related increase in the risk of anticholinergic toxicity owing to a decline in cholinergic transmission and increased permeability of the blood-brain barrier. 12 With polypharmacy so prevalent in the older population, it is not surprising that an older patient could be taking several anticholinergic medications that contribute to or worsen the pres entation of geriatric syndromes such as confusion and falls.…”

Section: Anticholinergic Loadmentioning

confidence: 99%

Managing polypharmacy in a 77-year-old woman with multiple prescribers

Farrell

Merkley

Thompson

2013

CMAJ

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Anticholinergic burden (prognostic factor) for prediction of dementia or cognitive decline in older adults with no known cognitive syndrome

Taylor‐Rowan

Edwards

Noel-Storr

et al. 2021

Cochrane Database of Systematic Reviews

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This is a protocol for a Cochrane Review (Prognosis). The objectives are as follows:Primary objective: to assess whether ACB in older adults is a prognostic factor for future cognitive decline or dementia. Secondary objective(s):to assess whether ACB is a prognostic factor for older adults recruited in primary care, secondary care, or community settings (with setting used as the basis for subgroup analyses); whether ACB is associated with mortality; to compare the prognostic validity of respective ACB scales; and to examine the e ect of duration of exposure and duration of follow-up on the ACBdementia risk association.Anticholinergic burden (prognostic factor) for prediction of dementia or cognitive decline in older adults with no known cognitive syndrome (Protocol)

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Association of Anticholinergic Burden with Cognitive and Functional Status in a Cohort of Hospitalized Elderly: Comparison of the Anticholinergic Cognitive Burden Scale and Anticholinergic Risk Scale

Cited by 151 publications

References 50 publications

Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes

Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes

Managing polypharmacy in a 77-year-old woman with multiple prescribers

Anticholinergic burden (prognostic factor) for prediction of dementia or cognitive decline in older adults with no known cognitive syndrome

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