CRIDECO Anticholinergic Load Scale: An Updated Anticholinergic Burden Scale. Comparison with the ACB Scale in Spanish Individuals with Subjective Memory Complaints

Abstract

The increase in life expectancy has also been accompanied by an increase in the use of medication to treat chronic diseases. Polypharmacy is associated with medication-related problems such as the increase in the anticholinergic burden. Older people are more susceptible to anticholinergic effects on the central nervous system and this, in turn, may be related to cognitive impairment. In this paper, we develop an updated anticholinergic burden scale, the CRIDECO Anticholinergic Load Scale (CALS) via a systematic review of the literature and compare it with the currently most used Anticholinergic Burden Scale (ACB). Our new scale includes 217 different drugs with anticholinergic properties, 129 more than the ACB. Given the effect that anticholinergic medications have on cognitive performance, we then used both scales to investigate the relationship between anticholinergic burden and cognitive impairment in adult Spanish subjects with subjective memory complaint. In our population, we observed an association between cognitive impairment and the anticholinergic burden when measured by the new CALS, but not when the ACB was applied. The use of a more comprehensive and upgraded scale will allow better discrimination of the risk associated with the use of anticholinergic medications on cognitive impairment. CALS can help raise awareness among clinicians of the problems associated with the use of medications, or combinations of them, with large anticholinergic effect, and promote a better personalized pharmacological approach for each patient.

Comparative analysis of anticholinergic burden scales to explain iatrogenic cognitive impairment and self-reported side effects in the euthymic phase of bipolar disorders: results from the FACE-BD cohort

“…We then adjusted the 21 models for the peripheral subscore and the 22 for the central subscore with the same set of previously selected covariates. Fourteen scales were significantly associated with the peripheral subscore in multiple logistic regression models when using the "max" method, the "sum" method, or both (Standardized β: 0.032 ≤ β ≤ 0.157; 0.09 ≤ R 2 ≤ 0.10) (Supplementary Table 4): the Anticholinergic Burden Classification (Ancelin et al, 2006), the Anticholinergic Risk Scale (Rudolph et al, 2008), the Anticholinergic Cognitive Burden scale (Boustani et al, 2008), the Anticholinergic Impregnation Scale (Briet et al, 2017), the Brazilian Anticholinergic Activity Drug Scale (Nery & Reis, 2019), the CRIDECO Anticholinergic Load Scale (Ramos et al, 2022), the Delirogenic Risk Scale (Hefner et al, 2015), Durán's scale (Durán et al, 2013), the German Anticholinergic Burden Scale (Kiesel et al, 2018), the Korean Anticholinergic 14 Burden Scale (Jun et al, 2019), the Muscarinic Acetylcholinergic Receptor ANTagonist Exposure Scale (Klamer et al, 2017), the modified Anticholinergic Cognitive Burden Scale of Joshi et al (2021), the modified Anticholinergic Risk Scale of Sumukadas et al (2016), and Salahudeen's scale (Salahudeen et al, 2015).…”

Increased anticholinergic medication use in middle‐aged and older autistic adults and its associations with self‐reported memory difficulties and cognitive decline

“…We used two scales to allow for a more rigorous and robust characterization of AC medications in the sample and to evaluate commonalities in findings across coding schemes. The ACB Scale has been widely used in studies of aging (see, inter alia, Abbreviations: AC, anticholinergic; ACB Scale, Anticholinergic Cognitive Burden Scale (Boustani et al, 2008;Campbell et al, 2013); AD8, Eight-item Interview to Differentiate Aging and Dementia (Galvin et al, 2005(Galvin et al, , 2007; CALS, CRIDECO Anticholinergic Load Scale (Ramos et al, 2022); PRMQ, Prospective and Retrospective Memory Questionnaire.…”

“…The CALS characterizes AC potency on a scale from 1 to 3, where 1 corresponds to "low potency" and 3 to "high potency." In developing the CALS, Ramos et al (2022) sought to provide an up-to-date, comprehensive scale of ACB. Using a systematic literature review following the PRISMA guidelines, the authors identified seven AC scales used in Ecuador, Germany, Korea, New Zealand, and the United States of America.…”

“…A UK population-based study of older adults aged ≥64 years indicated that 49.6% of the sample between 1990 and 1993 and 64.3% of the sample between 2008 and 2011 were taking at least one medication with anticholinergic effects (Grossi et al, 2020). Ramos et al (2022) characterized AC medication use in a sample of 512 Spanish adults (aged 50-96 years) with subjective memory complaints, who were grouped according to those with and without cognitive decline, as determined by cognitive testing. ACB was characterized using the CALS and an earlier version of the ACB Scale (Boustani et al, 2008) than that used in the present study.…”

“…. NoT A B L E 2 Regression model results with characterization of ACB based on the CRIDECO Anticholinergic Load Scale (CALS;Ramos et al, 2022): Hierarchical linear regression of PRMQ mean item score with sex assigned at birth, age at Time 1, and ACB total score or ACB cut-off score (≥3) (Study 1B), and hierarchical logistic regression of AD8 traditional (≥1) cut-off score and AD8 conservative (≥2) cut-off score with sex assigned at birth, age at Time 2, and ACB total score or ACB cut-off score (≥3) (Study 2). Sex assigned at birth was coded as follows: 0 = assigned male sex at birth, 1 = assigned female sex at birth female.…”