Drugs With Anticholinergic Properties, Cognitive Decline, and Dementia in an Elderly General Population

Carrière, Isabelle; Fourrier‐Réglat, Annie; Dartigues, Jean‐François; Rouaud, Olivier; Pasquier, Florence; Ritchie, Karen; Ancelin, Marie-Laure

doi:10.1001/archinternmed.2009.229

Cited by 322 publications

(269 citation statements)

References 43 publications

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“…Previously described examples such as Ipratropium 14 and Scopolamine 15 justify the extension of the present study by adding new drugs to the original ARS. In addition, repeating the study in a geriatric ward to compare cases of elderly people with different diagnostic and treatment dynamics would be worthwhile.…”

Section: Discussionmentioning

confidence: 60%

“…A mean consumption of 6.1 (±3.0) drugs not listed in ARS 5 (some with an anticholinergic action, such as Ipratropium and Scopolamine) 14,15 and 0.9(±0.6) drugs listed in ARS were identified: 1) Metoclopramide: in 80 medical records, used symptomatically; 2) Ranitidine: in 21 records; 3) Atropine: in three records; 4) Haloperidol: in three records; 5) Risperidone: in one medical record.…”

Section: Resultsmentioning

confidence: 99%

“…Anticholinergic drugs have the potential to trigger serious adverse effects, particularly among the elderly, such as falls, cognitive dysfunction and delirium [1][2][3][4][5][6][7][8][9][10][11]14 . They also contribute to increased mortality in this age group 1,3,6,9 .…”

Section: Discussionmentioning

confidence: 99%

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Applicability of Anticholinergic Risk Scale in hospitalized elderly persons

Gorzoni¹,

Fabbri²

2017

Rev. bras. geriatr. gerontol.

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Objective: to define the applicability of the Anticholinergic Risk Scale (ARS) as a risk indicator of delirium in hospitalized elderly persons. Method: the medical records of elderly patients hospitalized in the medical wards of a teaching hospital were analyzed with the ARS, translated and adapted for medicines used in Brazil. The version of the Confusion Assessment Method (CAM) for the clinical diagnosis of delirium translated and validated by Fabbri et al. was used. Individuals aged ≥60 years were included in the evaluation of drug use. The sample was divided by gender and age to analyze the effect of these variables on the use of anticholinergic drugs based on the ARS, and association with delirium. Results: 123 elderly persons, 47 men and 76 women, with a mean age of 72.7(±9.2) years were included. The average consumption of drugs not listed in the ARS (some with anticholinergic action as Ipratropium and Scopolamine) was 6.1(±3.0) and the average number of drugs used listed in the ARS (Metoclopramide, Ranitidine, Atropine, Haloperidol and Risperidone) was 0.9±0.6. Four elderly persons had a score ≥3 (3.3% of total cases). Delirium was observed in 27 patients (21.9% of the total), none of whom scored more than two ARS points. There was no statistical significance regarding gender, age and delirium. Conclusion: the average score of the ARS was low among this population, and did not correlate with delirium. The ARS does not cover all anticholinergics, meaning this study should be repeated in a geriatric ward for comparison.

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Section: Discussionmentioning

confidence: 60%

Section: Resultsmentioning

confidence: 99%

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Applicability of Anticholinergic Risk Scale in hospitalized elderly persons

Gorzoni¹,

Fabbri²

2017

Rev. bras. geriatr. gerontol.

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“…6,8,9 As estatinas poderão associar-se a deterioração cognitiva, com risco superior para as lipofíli-cas, que atravessam mais facilmente a BHE.…”

Section: 7unclassified

Declínio Cognitivo de Etiologia Medicamentosa

et al. 2014

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RESUMONos doentes idosos há um risco elevado de medicação inapropriada e de efeitos adversos da polimedicação. Doente do sexo feminino, 68 anos, previamente autónoma, recorre ao Serviço de Urgência por suspeita de Acidente Vascular Cerebral. Segundo o marido, nos seis meses prévios à admissão, apresentou progressiva dependência funcional e períodos de desorientação. Por esse motivo, havia recorrido a consultas de diferentes especialidades, encontrando-se polimedicada, sendo impossível perceber a posologia administrada. Apresentava-se desatenta, desorientada, apráxica, com mioclonias e marcha atáxica. Durante o internamento, após suspensão de toda a medicação crónica, revelou melhoria gradual, apresentando, à data de alta, exame neurológico completamente normal. A iatrogenia medicamentosa como causa reversível para quadros demenciais deve ser equacionada. Todos os doentes, particularmente os idosos e seus cuidadores, deverão ser adequadamente informados acerca dos medicamentos prescritos e da respetiva posologia. A utilização do modelo biopsicossocial poderá evitar a polimedicação inapropriada e a iatrogenia. Palavras-chave: Demência/induzida quimicamente; Doença Iatrogénica; Perturbações Cognitivas; Polimedicação; Portugal. ABSTRACTIn the elderly there is a high risk of inappropriate medication and adverse effects of polypharmacy. A 68 year-old female patient resorted to the Emergency Room for suspected stroke. According to the husband, in the six months prior to admission, she became progressively disorientated and dependent. She had resorted to various appointments from different specialties and was polymedicated. It was impossible to clarify the exact dosage. On neurological examination she presented disturbance in attention and memory, disorientation, constructional apraxia, myoclonus and gait imbalance. After the suspension of all chronic medication, she showed gradual improvement. By the time of discharge, her neurological examination was completely normal. Iatrogenic effect of drugs as a cause of reversible dementia should be considered. All patients, particularly the elderly and their caregivers, should be suitably informed about the drugs that are prescribed and the dosages used. Using the biopsychosocial model could prevent inappropriate polypharmacy and iatrogeny. Keywords: Cognition Disorders; Dementia/chemically induced; Iatrogenic Disease; Polypharmacy. INTRODUÇÃOEm Portugal, a população residente com 65 anos ou mais ultrapassou, em 2011, os dois milhões.1 A este fenó-meno associa-se um aumento da prevalência e incidência de patologias características desta faixa etária, com necessidade de consultas regulares e polimedicação. Para superar o desafio do envelhecimento deve garantir-se que as pessoas se mantenham saudáveis, ativas e autónomas durante o máximo tempo possível. 2A demência caracteriza-se por défice cognitivo que inclui compromisso da memória e pelo menos um dos seguintes: afasia, apraxia, agnosia e/ou perturbação da capacidade executiva. Deve ser suficientemente severo para comprometer o...

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“…However this has been questioned with trials reported anticholinergic medications may be associated with increased risk of longer term mild cognitive impairment or dementia post suspension of this medication [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?

et al. 2015

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Primary Objective: To assess the relationship between disability, length of stay (LOS) and anticholinergic burden (ACB) with people following acquired brain or spinal cord injury.Research Design: A retrospective case note review assessed total rehabilitation unit admission. Conclusions: There was a statistically significant correlation of ACB and neuro-disability measures and LOS amongst this patient cohort. Methods4

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Drugs With Anticholinergic Properties, Cognitive Decline, and Dementia in an Elderly General Population

Cited by 322 publications

References 43 publications

Applicability of Anticholinergic Risk Scale in hospitalized elderly persons

Applicability of Anticholinergic Risk Scale in hospitalized elderly persons

Declínio Cognitivo de Etiologia Medicamentosa

Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?

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