Impact of anticholinergic load on functioning and cognitive performances of persons with psychosis referred to psychosocial rehabilitation centers

Abstract

Background Few studies have explored whether high-anticholinergic load may hamper rehabilitation in persons with schizophrenia. We aim to explore the associations between anticholinergic load of psychotropic treatment and functioning or cognitive performances of persons with psychosis engaged in psychosocial rehabilitation. Methods The study was performed using data collected at baseline assessment in the REHABase cohort including persons referred to a French network of psychosocial rehabilitation centers. The composite-rating scale developed by Salahudeen et al. was used to rate the anticholinergic load of psychotropic drugs prescribed at baseline assessment. The associations between total anticholinergic load score (categorized as ‘low’ <3 v. ‘high’ ⩾3) and functioning or cognitive characteristics were explored using multivariate analyses. Results Of the 1012 participants with schizophrenia spectrum disorders identified in the REHABase, half used at least two psychotropic drugs with anticholinergic activity and one out of three was prescribed at least one psychotropic drug with high-anticholinergic activity. High-anticholinergic load was significantly associated with lower stage of recovery [odds ratio (OR) = 1.70, 95% confidence interval (CI) 1.05–2.76, p = 0.03], poor mental well-being (OR = 1.55, 95% CI 1.02–2.33, p = 0.04) and poor self-rated medication adherence (OR = 2.14, 95% CI 1.29–3.53, p = 0.003). Regarding cognition, a high-anticholinergic score was associated with poorer delayed-episodic memory (OR = 1.69, 95% CI 1.01–2.85, p = 0.05) and at the trend level with faster completion time on the test exploring executive performance (OR = 0.67, 95% CI 0.43–1.04, p = 0.07). Conclusions The psychosocial rehabilitation plan of persons with psychosis should integrate optimization of psychotropic treatment in order to lessen the functional and cognitive impact of high-anticholinergic load.

Anticholinergic load: A commonly neglected and preventable risk to cognition during schizophrenia treatment?

“…Cumulative anticholinergic load, as measured by the DBI, emerged as the most critical predictor of global cognitive score. This finding aligns with growing evidence suggesting that anticholinergic medications negatively impact global cognitive function in patients with schizophrenia ( Chahine, 2023 ; Haddad et al, 2023 ; Joshi et al, 2021 ; Kim et al, 2019 ; Minzenberg et al, 2004 ; Rehse et al, 2016 ; Spohn and Strauss, 1989 ; Verdoux et al, 2021 ; Vinogradov et al, 2009 ). In addition to antipsychotics, our patients also received antidepressants and benzodiazepines for comorbid symptoms, and these medications, as well as antiparkinsonian drugs prescribed to manage extrapyramidal side effects, further contribute to cumulative anticholinergic burden ( Chakos et al, 2006 ; Durán et al, 2013 ; Salahudeen et al, 2015 ; Su et al, 2017 ).…”

“…Regarding medications, although antipsychotics improve positive psychotic symptoms, high doses have been associated with increased cognitive deficits ( Georgiou et al, 2021 ; Kim et al, 2019 ). There are several explanations for how antipsychotic drugs may contribute to cognitive impairment, the most common being their anticholinergic burden ( Chahine, 2023 ; Haddad et al, 2023 ; Joshi et al, 2021 ; Kim et al, 2019 ; Minzenberg et al, 2004 ; Rehse et al, 2016 ; Spohn and Strauss, 1989 ; Verdoux et al, 2021 ; Vinogradov et al, 2009 ). In the short term, anticholinergic drugs may induce confusion and memory loss; while, in the long term, they increase the risk of dementia ( Coupland et al, 2019 ; Gray et al, 2015 ; Villalba-Moreno et al, 2016 ).…”

The central role of self-esteem in the quality of life of patients with mental disorders

“…We were interested in gathering information on the global structure of each disorder's network, as well as its overall connectivity, the strength of each connection between two dimensions, and the relative importance of each dimension. We extracted data from the REHABase cohort database 20 , which has been previously used in observational descriptive and associational studies on mental health services research [20][21][22][23][24][25][26] . The database contains observations across multiple psychosocial rehabilitation centres in France and presents the notable advantage of being both large and real-life.…”

Antipsychotic Effects on Longitudinal Cognitive Functioning in First-Episode Psychosis: A randomised, triple-blind, placebo-controlled study

“…While an anticholinergic mechanism could plausibly explain the observed decline in verbal learning and memory (36-38), risperidone/paliperidone have a relatively low risk for anticholinergic adverse effects (39). Furthermore, the doses prescribed here, while still effective (20), were lower than these previous studies.…”