Associations between Anticholinergic Burden and Adverse Health Outcomes in Parkinson Disease

Crispo, James A.G.; Willis, Allison W.; Thibault, Dylan; Fortin, Yannick; Hays, Harlen; McNair, Douglas S.; Bjerre, Lise M.; Kohen, Dafna; Pérez-Lloret, Santiago; Mattison, Donald R.; Krewski, Daniel

doi:10.1371/journal.pone.0150621

Cited by 88 publications

(94 citation statements)

References 66 publications

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“…There is also a high rate of use of anticholinergic drugs in many Asian countries for PD. Anticholinergics may aggravate cognitive decline and their role therefore needs to be examined [53]. …”

Section: Discussionmentioning

confidence: 99%

Non-Motor Symptoms Assessed by Non-Motor Symptoms Questionnaire and Non-Motor Symptoms Scale in Parkinson's Disease in Selected Asian Populations

Sauerbier

Jitkritsadakul²,

Titova³

et al. 2017

Neuroepidemiology

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Background: Ethnic variations have been described in medical conditions, such as hypertension, diabetes, and multiple sclerosis. Whether ethnicity plays a role in Parkinson's disease (PD), particularly with regard to non-motor symptoms (NMS), remains unclear. Existing literature is diverse, controversial, and inadequately documented. This review aims to analyse and report the currently available literature on NMS, specifically in Asian PD patients. Summary: We conducted a literature review using PubMed, searching for articles and currently available publications that reference and assess NMS in PD patients living in Asia using the validated NMS Questionnaire (NMS Quest) and NMS Scale (NMSS). In total, 24 articles were included: 12 using the NMS Quest and 12 using the NMSS. Symptoms of constipation, memory impairment, and nocturia were the most frequently self-reported symptoms (NMS Quest) in selected Asian populations, while symptoms within the domains sleep/fatigue, attention/memory, and mood/apathy were most prevalent when applying the health-professional completed NMSS. Key Messages: NMS are generally prevalent and highly burdensome within selected Asian PD populations living in countries included in this review. Our review suggests that NMS-driven phenotypic heterogeneity is present in Asian patients, and compared to Western PD populations there might be variations in assessed NMS.

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Section: Discussionmentioning

confidence: 99%

Non-Motor Symptoms Assessed by Non-Motor Symptoms Questionnaire and Non-Motor Symptoms Scale in Parkinson's Disease in Selected Asian Populations

Sauerbier

Jitkritsadakul²,

Titova³

et al. 2017

Neuroepidemiology

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“…Regarding anticholinergic use in particular, it has been demonstrated that the anticholinergic burden in patients with PD correlates with poor outcomes. 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 .…”

Section: Discussionmentioning

confidence: 99%

“…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 …”

mentioning

confidence: 99%

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

Dubaz

Cubillos

et al. 2019

Movement Disord Clin Pract

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Background During the past decade, there has been increasing awareness of the side effects of dopamine agonists (DAs), including impulse control disorders. We hypothesized that there may be a shift toward more conservative use of DAs. Objective To explore the change in prescribing practices for dopaminergic medications in Parkinson's disease between 2010 and 2017. Methods Data were collected from the Parkinson's Foundation Quality Improvement Initiative registry. Baseline characteristics were compared between the 2010 and 2017 cohorts using chi‐squared tests for discrete and t tests for continuous variables. Logistic regressions were conducted for each class of medications to assess the effect of time points (2010 vs. 2017) and prespecified covariates on the probability of prescribing. Results A total of 2,717 participants from 2010 and 2,900 participants from 2017 were included in the analysis. Mean (standard deviation) age was 67.4 (10) and 68.7 (9.3) for the 2010 and 2017 cohorts, respectively (P < 0.0001). After controlling for baseline characteristics, DA use was unchanged (P = 0.1172). The odds of using monoamine oxidase B inhibitors was 52% higher in 2017 than in 2010 (P < 0.0001), 38% lower for catechol‐O‐methyltransferase inhibitors (P < 0.0001), 25% lower for amantadine (P < 0.0001), and 31% lower for anticholinergics (P = 0.0153). There was no difference in the utilization of levodopa in the 2 cohorts (86.1% vs. 86.2%; P = 0.5783). Conclusions Despite increasing awareness of impulse control disorders, there has been no reduction in the use of DAs during the past decade. Overall, there is less utilization of adjunctive classes of drugs except for an increase in the use of monoamine oxidase B inhibitors.

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“…There is limited previous research on anticholinergic drug use in specific populations. Anticholinergic drug use has been evaluated, for example in persons with cognitive impairment, schizophrenia and Parkinson’s disease . There are a few previous studies investigating anticholinergic drug use in persons with diabetes .…”

Section: What Is Known and Objectivementioning

confidence: 99%

Anticholinergic drug use and its association with self-reported symptoms among older persons with and without diabetes

et al. 2018

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Summary What is known and objective Anticholinergic drug use has been associated with a risk of central and peripheral adverse effects. There is a lack of information on anticholinergic drug use in persons with diabetes. The aim of this study is to investigate anticholinergic drug use and the association between anticholinergic drug use and self‐reported symptoms in older community‐dwelling persons with and without diabetes. Methods The basic population was comprised of Finnish community‐dwelling primary care patients aged 65 and older. Persons with diabetes were identified according to the ICD‐10 diagnostic codes from electronic patient records. Two controls adjusted by age and gender were selected for each person with diabetes. This cross‐sectional study was based on electronic primary care patient records and a structured health questionnaire. The health questionnaire was returned by 430 (81.6%) persons with diabetes and 654 (73.5%) persons without diabetes. Data on prescribed drugs were obtained from the electronic patient records. Anticholinergic drug use was measured according to the Anticholinergic Risk Scale. The presence and strength of anticholinergic symptoms were asked in the health questionnaire. Results and discussion The prevalence of anticholinergic drug use was 8.9% in the total study cohort. There were no significant differences in anticholinergic drug use between persons with and without diabetes. There was no consistent association between anticholinergic drug use and self‐reported symptoms. What is new and conclusion There is no difference in anticholinergic drug use in older community‐dwelling persons with and without diabetes. Anticholinergic drug use should be considered individually and monitored carefully.

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Associations between Anticholinergic Burden and Adverse Health Outcomes in Parkinson Disease

Cited by 88 publications

References 66 publications

Non-Motor Symptoms Assessed by Non-Motor Symptoms Questionnaire and Non-Motor Symptoms Scale in Parkinson's Disease in Selected Asian Populations

Non-Motor Symptoms Assessed by Non-Motor Symptoms Questionnaire and Non-Motor Symptoms Scale in Parkinson's Disease in Selected Asian Populations

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

Anticholinergic drug use and its association with self-reported symptoms among older persons with and without diabetes

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