Dose response relationship of cumulative anticholinergic exposure with incident dementia: validation study of Korean anticholinergic burden scale

Abstract

Background The dose response relationship of nine-year cumulative anticholinergic exposure and dementia onset was investigated using the Korean version anticholinergic burden scale (KABS) in comparison with the Anticholinergic Cognitive Burden Scale (ACB). We also examined the effect of weak anticholinergics in the prediction of dementia. Methods A retrospective case-control study was conducted comprising 86,576 patients after 1:2 propensity score matching using the longitudinal national claims database. For cumulative anticholinergic burden estimation, average daily anticholinergic burden score during the 9 years prior to dementia onset was calculated using KABS and ACB and categorized as minimal, < 0.25; low, 0.25–1; intermediate, 1–2; and high, ≥ 2. Adjusted odds ratio (aOR) between cumulative anticholinergic burden and incident dementia was estimated. Results Patients with high exposure according to KABS and ACB comprised 3.2 and 3.4% of the dementia cohort and 2.1 and 2.8% of the non-dementia cohort, respectively. Dose-response relationships were observed between anticholinergic burden and incident dementia. After adjusting covariates, compared with minimal exposure, patients with high exposure according to KABS and ACB had a significantly higher risk for incident dementia with aOR of 1.71 (95% confidence interval (CI) 1.55–1.87) and 1.22 (CI 1.12–1.33), respectively. With the exclusion of weak anticholinergics, the association became stronger, i.e., 1.41 (CI 1.14–1.75) with ACB whereas the association became slightly weaker with KABS, i.e., 1.60 (CI 1.38–1.86). Conclusion This study confirmed the dose response relationship for cumulative anticholinergic burden measured using the Korean specific anticholinergic burden scale with incident dementia.

Factors associated with anticholinergic burden among older patients in long-term care hospitals in Korea

“…In previous observational and retrospective cohort studies, a high burden of DAPs was associated with adverse cognitive impact or incident dementia [15,34]. However, in an-other study, similar to the current study, the use of DAPs was associated with better cognition and functioning [9,30].…”

“…Due to differences in prescribing patterns and medication availability across countries, country-specific anticholinergic burden scales have been developed. In Korea, the Korean Anticholinergic Burden Scale (KABS) was developed and validated based on literature evaluation and a modified Delphi process [14,15]. KABS was validated in a claim-based case-control study on the dose-response relationship between KABS www.kjim.org https://doi.org/10.3904/kjim.2021.457 burden and incident dementia [15].…”

A Knowledge, Attitude, and Practice Survey on Medication Safety in Korean Older Adults: An Analysis of an Ageing Society

“…Furthermore, most respondents reported the habitual use of these OTC drugs more than once per week or more than once per month. There are some concerns about the health management and OTC drug use practices of older adults because some of them indicated that their medications include nonsteroidal anti-inflammatory drugs or H2 blockers listed in the Beers criteria [40][41][42][43]. The Beers criteria, which were initially developed by an expert consensus panel in 1991, are the most widely used criteria for determining medications that are inappropriate for use by older individuals due to their high risk of adverse drug events [41].…”

Effect of chemotherapy and radiotherapy on cognitive impairment in colorectal cancer: evidence from Korean National Health Insurance Database Cohort

“…Cognitive impairment was defined as the presence of at least 1 ICD-10 diagnostic code for dementia or minor cognitive impairment [ 16 , 17 ]. The ICD-10 codes for dementia and minor cognitive impairments are listed in Supplementary Material 1 .…”