Effect of anticholinergic drugs on cognitive impairment in the elderly

López-Álvarez, Jorge; Sevilla, María Ascensión Zea; Ortiz, Luis F. Agüera; Fernández-Blázquez, Miguel A.; Valentí-Soler, Meritxell; Martinez‐Martín, Pablo

doi:10.1016/j.rpsmen.2015.03.001

Cited by 12 publications

(8 citation statements)

References 50 publications

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“…Physicians must be aware that, in addition to classical atropinic antiparkinsonian drugs, several others such as psychotropics also possess lateral atropinic effects that can be clinically importantly harmful for PD patients. With regard to the well‐established putative consequences of this widespread use of atropinics (serious adverse drug reactions for a reduced clinical efficacy), large, widespread information campaigns for minimizing atropinic prescriptions in PD patients should be urgently undertaken. Atropinic risk scales, like Duran's list can help prescribers in clinical practice.…”

Section: Resultsmentioning

confidence: 99%

“…In fact, the benefit‐harm balance of atropinic drugs is widely debated in general populations and especially in the elderly because they can induce several adverse drug reactions that are often “serious”: intestinal paresis, xerostomia, blurred vision, increase in heart rate, dyspepsia, dizziness, confusion, memory loss, or cognitive impairment . In older patients, they increased the risk of falls, and their use was associated with increased mortality .…”

Section: Atropinic Risk Scalesmentioning

confidence: 99%

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Atropinic (Anticholinergic) Burden in Parkinson's Disease

et al. 2016

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Use of atropinic drugs remains controversial in Parkinson's disease (PD) because there is insufficient evidence about their efficacy and they can induce serious adverse drug reactions. Atropinic risk scales were developed to help to identify atropinic drugs in prescription forms and to evaluate their burden in clinical practice. In the present review, we discuss the few studies investigating atropinic burden in PD and present the results of our study indicating that atropinic drugs are still widely prescribed in PD (almost 3 of 5 prescriptions) with a clinically significant atropinic burden in around 1 of 6 PD patients. Drugs mainly responsible for high values of atropinic burden were those used for nonmotor symptoms. Clinically significant atropinic burdens were mainly induced by associations of several "low-risk" drugs. Physicians must be aware that in addition to classical atropinic antiparkinsonian drugs, many others (psychotropics) can contribute to increased atropinic burden in PD patients. © 2016 International Parkinson and Movement Disorder Society.

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Section: Resultsmentioning

confidence: 99%

Section: Atropinic Risk Scalesmentioning

confidence: 99%

Atropinic (Anticholinergic) Burden in Parkinson's Disease

et al. 2016

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“…For this we may need to improve knowledge and understanding of anticholinergic medicines and switch patients' prescriptions to lower anticholinergic burden when they are at risk of falls (or confusion). 35 In addition, we would explore ways in which the electronic prescribing record system could alert to the need for a medicines review following medicines reconciliation documentation as described by Graabaek et al . 36 …”

Section: Discussionmentioning

confidence: 99%

Deprescribing medicines in the acute setting to reduce the risk of falls

et al. 2016

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BackgroundFalls are a common cause of morbidity and hospitalisation in older people. Inappropriate prescribing and polypharmacy contribute to falls risk in elderly patients. This study's aim was to quantify the problem and find out if medication review in the hospital setting led to deprescribing of medicines associated with falls risk.MethodsAdmissions records for elderly patients were examined to identify those whose presenting complaint included a fall. Inpatient medication charts, pharmaceutical care notes, medical notes and discharge summaries were examined to identify any falls-risk medicines from admission histories and to determine if any medication review took place, and whether or not changes were made as a result. In particular deprescribing and dose reduction details were analysed.Results100 patients over 70 years old were admitted following a fall during the 2 months study period. The mean number of medicines on admission was 6.8 per patient with polypharmacy found in 62/100 (62%). One or more falls-risk medicine was found in 65/100 (65%) patients. Medicines review was carried out in 86/100 (86%) of patients, and 59/697 (8.5%) medicines were deprescribed. Pharmacist involvement in medication review led to a significant reduction in the number of falls-risk medicines per patient (p=0.002).ConclusionsInappropriate prescribing and polypharmacy are found frequently in elderly patients at admission following a fall. Comprehensive medicines reviews should be carried out in all such patients with the objective of deprescribing or reducing doses to minimise risk of harm. Involvement of a pharmacist improves the rate of reduction of falls-risk medicines.

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“…Cholinergic deficit plays a central role in the pathophysiology of Alzheimer's disease. The muscarinic system in the central nervous system mediates processes of attention, learning and short‐term memory; therefore, the use of anticholinergic drugs can produce impaired cognitive function, drowsiness, delirium, hallucinations, confusion, an increased risk of falls and poor quality of life …”

Section: Introductionmentioning

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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Effect of anticholinergic drugs on cognitive impairment in the elderly

Cited by 12 publications

References 50 publications

Atropinic (Anticholinergic) Burden in Parkinson's Disease

Atropinic (Anticholinergic) Burden in Parkinson's Disease

Deprescribing medicines in the acute setting to reduce the risk of falls

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

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