Centrally-acting anticholinergic drugs– associations with mortality, hospitalisation and cognitive decline following dementia diagnosis in people receiving antidepressant and antipsychotic drugs

Bishara, Delia; Perera, Gayan; Harwood, Daniel; Taylor, David; Sauer, Justin; Funnell, Nicola; Gee, Siobhan; Stewart, Robert; Mueller, Christoph

doi:10.1080/13607863.2021.1947967

Cited by 8 publications

(13 citation statements)

References 29 publications

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“…48 Also, there were significant association between antipsychotic drugs and cognitive decline in same dementia cohort regardless of centrally acting anticholinergic effect. 49 Some drug groups such as α1 antagonist, antihistamines, N-methyl-D-aspartate receptor antagonists, and psychotropic sedatives were associated with accelerated cognitive decline in dementia patients. 50 However, we could not find any studies that specifically explored the cognitive changes associated with the use of anticholinergic drugs in patients with DLB.…”

Section: Discussionmentioning

confidence: 99%

“…It has been observed that drugs used in the treatment of urinary incontinence and depression, cause poor results in terms of cognitive decline in dementia patients due to their centrally acting anticholinergic effects 48 . Also, there were significant association between antipsychotic drugs and cognitive decline in same dementia cohort regardless of centrally acting anticholinergic effect 49 . Some drug groups such as α1 antagonist, antihistamines, N -methyl- d -aspartate receptor antagonists, and psychotropic sedatives were associated with accelerated cognitive decline in dementia patients 50 .…”

Section: Discussionmentioning

confidence: 99%

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Association of Anticholinergic Drug Burden With Cognitive and Functional Decline Over Time in Dementia With Lewy Bodies: 1-Year Follow-Up Study

Ozsurekci,

Satis,

Demircan

et al. 2024

Clin Neuropharm

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Background The purpose of this study was to investigate the relationship between anticholinergic burden (ACB), and cognitive and functional alterations in patients with dementia of Lewy bodies (DLB) during a 1-year follow-up period. Methods This cohort study included patients diagnosed with DLB admitted to a tertiary geriatric outpatient clinic. Cognition, functional performance, and nutritional status were assessed at baseline, 6 months, and 12 months during the follow-up period. The ACB was evaluated, and participants were grouped as ACB ≥1 and ACB=0. Results A total of 112 patients with DLB (mean age, 79.3 ± 6.8 years; 50.9% female) were included. The mean number of medications was 5.1 ± 4, 56.9% of participants had polypharmacy, and 55.2% had an anticholinergic drug burden. Individuals with ACB ≥1 had lower instrumental activities of daily living (IADL) scores at baseline than those with ACB=0 (P=0.014). The Barthel index and Lawton-Brody IADL scores significantly decreased in the ACB ≥1 group on repetitive measurements over time, whereas only the Lawton-Brody IADL scores worsened in the ACB=0 group (all P<0.001). There were no significant differences in cognitive scores and Mini-Mental State Examination subdomains between the groups. The dependent variable repetitive test revealed a significant deterioration in the orientation subdomain in the ACB ≥1 group over time (P=0.001). Multivariable regression models showed no significant effect of ACB score on cognitive and functional impairment. Conclusion Our study provides evidence that the use of anticholinergic drugs in this vulnerable population may potentially increase the morbidity by adversely affecting functional status and cognitive orientation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of Anticholinergic Drug Burden With Cognitive and Functional Decline Over Time in Dementia With Lewy Bodies: 1-Year Follow-Up Study

Ozsurekci,

Satis,

Demircan

et al. 2024

Clin Neuropharm

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“…Antidepressants and antipsychotics were also examined separately to investigate their effects on outcomes in dementia. Studies found that the influence of anticholinergic burden did not increase mortality with antidepressants 32,37 or antipsychotics 37 in people with dementia and if anything, a reverse association was found with antidepressants. 37 So contrary to expectation, tricyclic antidepressants were safer than antidepressants with low anticholinergic burden.…”

Section: The Evidencementioning

confidence: 98%

Anticholinergic action is rarely a good thing

Bishara

2023

Therapeutic Advances in Psychopharmacology

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The evidence for the risks associated with anticholinergic agents has grown considerably in the last two decades. Not only are they associated with causing peripheral side effects such as dry mouth, blurred vision and constipation, but they can also cause central effects such as cognitive impairment; and more recently, they have consistently been linked with an increased risk of dementia and death in older people. This paper reviews the evidence for the associations of anticholinergic agents and the risk of dementia and increased mortality in dementia.

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“…the Anticholinergic Cognitive Burden Scale, 25 the Anticholinergic Risk Scale, 26 the Anticholinergic Drug Scale, 27 and the Drug Burden Index) 28 . The use of drugs with anticholinergic activity and high ACB is linked to adverse events such as reduced physical functioning, falls, reduced quality of life, hospitalisation, and mortality among PwD 29–34 . Reduction of anticholinergic drug use and ACB in PwD has therefore been highlighted as a research priority 14…”

Section: Introductionmentioning

confidence: 99%

“…28 The use of drugs with anticholinergic activity and high ACB is linked to adverse events such as reduced physical functioning, falls, reduced quality of life, hospitalisation, and mortality among PwD. [29][30][31][32][33][34] Reduction of anticholinergic drug use and ACB in PwD has therefore been highlighted as a research priority. 14 Following diagnosis, PwD will be predominantly managed and supported within primary care settings.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of interventions to reduce anticholinergic burden in older people with dementia in primary care

Shawaqfeh¹,

Hughes²,

Barry³

2022

Int J Geriat Psychiatry

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Objective: This systematic review aimed to assess the types and effectiveness of interventions that sought to reduce anticholinergic burden (ACB) in people with dementia (PwD) in primary care. Methods:One trial registry and eight electronic databases were systematically searched to identify eligible English language studies from inception until December 2021. To be eligible for inclusion, studies had to be randomised controlled trials (RCTs) or non-randomised studies (NRS), including controlled before-and-after studies and interrupted time-series studies, of interventions to reduce ACB in PwD aged ≥65 years (either community-dwelling or care home residents). All outcomes were to be considered. Quality was to be assessed using the Cochrane Risk of Bias tool for RCTs and ROBINS-I tool for NRS. If data could not be pooled for meta-analysis, a narrative synthesis was to be conducted. Results:In total, 1880 records were found, with 1594 records remaining after removal of duplicates. Following title/abstract screening, 13 full-text articles were assessed for eligibility. None of these studies met the inclusion criteria for this review. Reasons for exclusion were incorrect study design, ineligible study population, lack of focus on reducing ACB, and studies conducted outside the primary care setting. Conclusions: This 'empty' systematic review highlights the lack of interventions to reduce ACB in PwD within primary care, despite this being highlighted as a priority area for research in recent clinical guidance. Future research should focus on development and testing of interventions to reduce ACB in this patient population through high-quality clinical trials.

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Centrally-acting anticholinergic drugs– associations with mortality, hospitalisation and cognitive decline following dementia diagnosis in people receiving antidepressant and antipsychotic drugs

Abstract: C. (2021). Centrally-acting anticholinergic drugs-associations with mortality, hospitalisation and cognitive decline following dementia diagnosis in people receiving antidepressant and antipsychotic drugs. Aging and Mental Health.

Cited by 8 publications

References 29 publications

Association of Anticholinergic Drug Burden With Cognitive and Functional Decline Over Time in Dementia With Lewy Bodies: 1-Year Follow-Up Study

Association of Anticholinergic Drug Burden With Cognitive and Functional Decline Over Time in Dementia With Lewy Bodies: 1-Year Follow-Up Study

Anticholinergic action is rarely a good thing

A systematic review of interventions to reduce anticholinergic burden in older people with dementia in primary care

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