The effect of anticholinergic burden on cognitive and daily living functions in patients with schizophrenia

Kim, Sungjin; Jung, Do-Un; Shim, Joo-Cheol; Moon, Jung-Joon; Jeon, Dong-Wook; Kim, You-Na; Seo, Young-Soo; Jung, Sung-Soo; Seo, Beomjoo; Kim, Jeongeun

doi:10.1016/j.ajp.2019.10.013

Cited by 28 publications

(18 citation statements)

References 41 publications

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“…Anticholinergic activity can cause cognitive decline, falls, constipation and daytime drowsiness in older people [ 7 , 8 ], and worsen cognition and activities of daily living in people living with schizophrenia [ 9 ]. Greater cumulative use of anticholinergics has been associated with an increased risk of dementia [ 10 – 12 ], and mortality [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Increasing prevalence of anticholinergic medication use in older people in England over 20 years: cognitive function and ageing study I and II

et al. 2020

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Background: Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality, and their use should be limited in older people. Here we estimate the prevalence of anticholinergic use in England's older population in 1991 and 2011, and describe changes in use by participant's age, sex, cognition and disability. Methods: We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990-1993 (N = 7635) and 2008-2011 (N = 7762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score = 3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Results: Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2-6.3%) of the older population in 1990-93 to 9.9% (9.3-10.7%) in 2008-11, adjusted odds ratio of 1.90 (95% CI 1.67-2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergics in CFAS II (16.5% [95% CI 12.0-22.3%]). Large increases in the prevalence of the use medication with 'any' anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Conclusions: Use of potent anticholinergic medications nearly doubled in England's older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects.

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Section: Introductionmentioning

confidence: 99%

Increasing prevalence of anticholinergic medication use in older people in England over 20 years: cognitive function and ageing study I and II

et al. 2020

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“…Anticholinergic activity can cause cognitive decline, falls, constipation and daytime drowsiness in older people [7] [8], and worsen cognition and activities of daily living in people living with schizophrenia [9]. Greater cumulative use of anticholinergics has been associated with an increased risk of dementia [10] [11] [12], and mortality [7] .…”

Section: Introductionmentioning

confidence: 99%

Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

Grossi

Richardson

Savva

et al. 2020

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Background: Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality, and their use should be limited in older people. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability.Methods: We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990-1993 (N=7,635) and 2008-2011 (N=7,762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score=3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Results: Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2-6.3%) of the older population in 1990-93 to 9.9% (9.3-10.7%) in 2008-11, adjusted odds ratio of 1.90 (95%CI 1.67 – 2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergic in CFAS II (16.5% [95%CI 12.0-22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Conclusions: Use of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects.

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“…In terms of side effect of drugs, antipsychotics could induce cognitive dysfunction as a side effect. Especially, clinicians should pay attention to SZ patients who take antipsychotics that have an anticholinergic effect [61,62]. In addition, it has been reported that the tapering of benzodiazepine and anticholinergic rescue cognitive function [63,64].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of possible idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia: a replication study

et al. 2020

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Background: We recently reported that older patients with schizophrenia (SZ) show possible idiopathic normal pressure hydrocephalus (iNPH) more frequently than the general population. In this study, we estimated the prevalence of iNPH in a larger number of older SZ patients and explored useful examination values for diagnosis in the SZ population. Methods: We enrolled older inpatients with SZ (n = 39, mean age = 68.6 ± 7.7 years) from several psychiatric hospitals in Ehime, Japan and acquired brain imaging data using computed tomography. We evaluated three iNPH symptoms (dementia, gait disturbance, and urinary incontinence). In addition, we combined these data with our previous data to elucidate the relationship between iNPH and characteristics of SZ symptoms. Results: In total, five (12.8%) patients were diagnosed with possible iNPH. Evans' index for patients with iNPH was significantly higher than for those without iNPH (p = 0.002). The number of disproportionately enlarged subarachnoid space hydrocephalus (DESH) findings was significantly higher in patients with iNPH than in those without iNPH (p < 0.001). Using combined data, Drug-Induced Extra-pyramidal Symptoms Scale (DIEPSS) subscales of gait and bradykinesia showed an increasing trend in the SZ with iNPH group. Conclusions: We reconfirmed that older inpatients with SZ experienced possible iNPH more frequently than the general population. We should pay attention to the DIEPSS subscales of gait and bradykinesia and DESH findings in addition to the three main symptoms of iNPH and Evans' index so as to not miss SZ patients with iNPH.

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The effect of anticholinergic burden on cognitive and daily living functions in patients with schizophrenia

Cited by 28 publications

References 41 publications

Increasing prevalence of anticholinergic medication use in older people in England over 20 years: cognitive function and ageing study I and II

Increasing prevalence of anticholinergic medication use in older people in England over 20 years: cognitive function and ageing study I and II

Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

Prevalence of possible idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia: a replication study

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