Comedication and Treatment Length in Users of Acetylcholinesterase Inhibitors

Efjestad, Anne Sverdrup; Ihle‐Hansen, Hege; Hjellvik, Vidar; Blix, Hege Salvesen

doi:10.1159/000454948

Cited by 17 publications

(22 citation statements)

References 33 publications

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“…The authors explained that the lack of effect in dementia patients contrary to the positive findings in non‐dementia patients may be due to decreased sensitivity or an impact on cognitive function before enrolment in the study. A study from Norway reported that patients with a high anticholinergic burden were associated with early discontinuation of anti‐dementia treatment …”

Section: Discussionmentioning

confidence: 99%

Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population‐based study

Suh

Jun

et al. 2019

Basic Clin Pharma Tox

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Few studies have evaluated the association between anticholinergic burden and treatment modification after starting a cholinesterase inhibitor in clinical practice.We aimed to evaluate the effect of anticholinergic burden on anti-dementia treatment modification, delirium and mortality. We retrospectively analysed older adults (n = 25 825) who started a cholinesterase inhibitor during 2003-2011 from Korean National Health Insurance Service Senior Cohort Database. High anticholinergic burden was defined as an average daily Anticholinergic Cognitive Burden (ACB) score of >3 during the first 3 months. We investigated the impact of high anticholinergic burden on the rate of treatment modification, delirium and mortality in comparison with minimal ACB (ACB score ≤1) in propensitymatched cohorts (N = 7438). Approximately 6.0% of patients with dementia were exposed to a high anticholinergic burden within the first three months of treatment. In high anticholinergic burden cohorts, significantly more patients experienced treatment modification (34.9% vs. 32.1%) or delirium (5.6% vs. 3.6%) and the mortality rate was also higher (16.8% vs. 14.1%) than controls. A multivariate Cox proportional hazard regression analysis showed that an average ACB score >3 within the first three months significantly increased the risk of treatment modification (hazard ratio (HR): 1.12, 95% confidence interval (CI): 1.02-1.24), delirium (HR: 1.52, CI: 1.17-1.96) and mortality (HR: 1.23, CI: 1.06-1.41). This study showed that high anticholinergic burden negatively affected the treatment response to cholinesterase inhibitors and that an average ACB score >3 was an independent prognostic factor for delirium or mortality in dementia patients.

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Section: Discussionmentioning

confidence: 99%

Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population‐based study

Suh

Jun

et al. 2019

Basic Clin Pharma Tox

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“…Patients with Alzheimer's disease are often treated with multiple psychotropic drugs (antipsychotics, antidepressants, anxiolytics, hypnotics and sedatives to control various behavioral and psychological symptoms). Using these drugs can lead to serious side‐effects, because many drugs also have anticholinergic properties, with the additional drawback that in some cases safer alternatives are not available …”

Section: Discussionmentioning

confidence: 99%

Potentially inappropriate prescriptions of anticholinergics drugs in Alzheimer's disease patients

Valladales‐Restrepo

Duran-Lengua

Machado‐Alba

2019

Geriatrics Gerontology Int

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Aim: Alzheimer's disease is a common cause of dementia, and is usually treated with medications that elevate acetylcholine levels. The objective of the present study was to identify drugs with anticholinergic properties prescribed to patients diagnosed with Alzheimer's disease in Colombia. Methods:A cross-sectional study was carried out in outpatients diagnosed with Alzheimer's disease who were identified from a population database from Colombia, and had been treated with cholinesterase inhibitors and glutamate N-methyl-D-aspartate receptor antagonists. The anticholinergic burden was evaluated using the Anticholinergic Cognitive Burden scale, and patients were classified on a scale of 0-3 points according to anticholinergic potential, and were grouped into those with mild-to-moderate (1-2 points) or high (≥3 points) anticholinergic load.Results: The study included 4134 Alzheimer's disease patients. The mean age was 81.50 AE 8.16 years, and 67.8% were women. At least 22.9% of patients took anticholinergic drugs. Of these, the most frequently prescribed medication was quetiapine (8.6%). Age >85 years was associated with a high risk of having an anticholinergic burden ≥3 points (OR 2.19,. Potential interactions between cholinesterase inhibitors and anticholinergic drugs were identified in 7.8% of patients. Conclusions:The majority of patients who were prescribed anticholinergic drugs were older women, had a significant total anticholinergic burden and had frequent pharmacological interactions with cholinesterase inhibitors. The use of anticholinergics reduces the clinical effectiveness of antidementia drugs and increases the risk of adverse reactions. Geriatr Gerontol Int 2019; 19: 913-917.

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“…Medication education and pharmacist-counseling have been associated with improved adherence and treatment persistence with AChEIs [ 27 , 28 , 29 ]. Inappropriate medications among community-dwelling persons with AD are relatively common including over-the-counter first-generation antihistamines with central anticholinergic AEs that can negatively impact cognition [ 30 , 31 ]. High-quality patient education on AChEIs and appropriate self-care recommendations for non-cognitive problems associated with dementia are a good starting point.…”

Section: Discussionmentioning

confidence: 99%

Community Pharmacists’ Knowledge Regarding Donepezil Averse Effects and Self-Care Recommendations for Insomnia for Persons with AD

Marvanová

Henkel

2017

Pharmacy

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Alzheimer’s disease (AD) impacts millions of individuals worldwide. Since no cure is currently available, acetylcholinesterase inhibitors are symptomatic therapy. This study assessed community pharmacists’ knowledge regarding donepezil adverse effects (AEs) and self-care recommendations for insomnia management for persons with AD treated with rivastigmine. This is a cross-sectional, standardized telephone survey of community pharmacists (n = 862) in three study areas: West Virginia, North Dakota/South Dakota, and Southern Oregon/Northern California. Pharmacists’ degree, sex, and pharmacists’ AD-related knowledge were assessed. In-stock availability of donepezil and rivastigmine formulations was assessed. Analyses were performed using Stata 10.1. Only 31.4% pharmacists were able to name ≥2 donepezil AEs. Only four donepezil AEs were named by at least 13% of pharmacists: nausea (36.1%), dizziness (25.1%), diarrhea (15.0%), and vomiting (13.9%). All other AEs were named by fewer than 7% of respondents. Only 62.9% of pharmacists (n = 542) provided appropriate recommendations: melatonin (40.3%), referral to physician (22.0%), or sleep hygiene (0.6%). Over 12% of pharmacists (n = 107) provided inappropriate recommendations (anticholinergic agent or valerian root) and 21.5% of pharmacists were unable to provide any recommendation. We identified significant gaps in community pharmacists’ knowledge regarding donepezil AEs and non-prescription insomnia recommendation needing significant improvement to ensure high-quality AD-related care.

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Comedication and Treatment Length in Users of Acetylcholinesterase Inhibitors

Cited by 17 publications

References 33 publications

Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population‐based study

Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population‐based study

Potentially inappropriate prescriptions of anticholinergics drugs in Alzheimer's disease patients

Community Pharmacists’ Knowledge Regarding Donepezil Averse Effects and Self-Care Recommendations for Insomnia for Persons with AD

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