Drugs with Anticholinergic Properties as a Risk Factor for Psychosis in Patients Affected by Alzheimer’s Disease

Abstract

Emerging evidence suggests that psychosis in persons with Alzheimer's disease (AD) may be linked to the cholinergic deficit associated with the disease. This study sought to evaluate whether anticholinergic (ACH) drugs could be a risk factor for psychosis onset. A total of 230 patients affected with probable AD were recruited. Data on behavioral and psychological symptoms were collected using the Neuropsychiatric Inventory, and diagnosis of psychosis was performed. Patients were divided into those who used ACH drugs and those who used non-ACH drugs. Those using ACH drugs (18.3%) were more likely to have psychosis than those using non-ACH drugs (odds ratio (OR)=2.52; 95% confidence interval (CI), 1.27-5.00); this association remained significant even after adjusting for potential confounding variables (OR=2.13; 95% CI, 1.03-4.43). Our data suggest that patients with AD are frequently treated with ACH drugs and that ACH drug intake should be regarded as a potential risk factor for psychosis.

Drugs With Anticholinergic Properties as a Risk Factor for Cognitive Impairment in Elderly People

“…13 Briefly, we used a method that combines the use of a list of ACH drugs, with clinical judgment. 21 We performed an extensive literature review to establish a list of drugs with ACH properties, along with their serum ACH activity as estimated by radioreceptor assays 3,21,22 ; subsequently, the ACH effect of each drug in each patient was classified as follows: level 0 = drug with no ACH effect; level 1 = drug with no likely ACH effect; level 2 = drug with a moderate ACH effect; and level 3 = drug with a high ACH effect.…”

“…5 Elderly people are more likely than younger patients to develop central ACH side effects: previous studies suggested a possible relationship between the ACH drug intake and cognitive impairment, 6-9 delirium, 10,11 and psychosis. 12,13 This predisposition has been linked to an age-related deficit in central cholinergic transmission and to a deficient drug metabolism. 14 The use of multiple drugs further increases the probability and severity of ACH adverse events.…”

Capturing side-effect of medication to identify persons at risk of delirium

“…It is well known that drugs with anticholinergic activity are an important precipitating factors for delirium in older persons (8). Some reports indicate that medications may be the sole precipitating factor in almost 30% of cases of delirium.…”

An anticholinergic burden score for German prescribers: score development

“…To avoid missing relevant tools, the excluded articles were reviewed regarding more tools as they all evaluated the association of anticholinergic drugs and negative outcomes in patients [ 9 , 19 , 27 , 38 , 39 ]. These reviews identified four further tools, all ineligible for inclusion because (1) it was impossible to access the drug list despite contacting the authors [ 28 , 31 ], (2) the scoring system was not comparable to other drug lists [ 29 ], and (3) the study assessed the overall medication of patients not specific drugs [ 30 ]. The included anticholinergic drug lists were summarized and reduced to drugs available in Germany [ 10 , 20 – 24 , 26 ].…”