Use of drugs with anticholinegic effects and cognitive impairment in community-living older persons

Abstract

Many drugs with anticholinergic effects are often prescribed for the elderly for various therapeutic reasons such as Parkinson's disease, urge incontinence and mood disturbances. Various reports estimated that drugs with anticholinergic effects are used by between 13.7% and 27% of the community-living elderly [1-3] and as much as 60% in nursing homes residents [4]. The unwanted peripheral and central side-effects are well known and common and include cognitive impairment [5] but are often attributed to normal consequences of ageing or the disease process. Acetylcholine levels decrease with advancing age and reduced cholinergic activity is a characteristic feature of dementia including Alzheimer's disease [6]. The use of drugs with anticholinergic effects is clearly an important exogenous source of anticholinergic load in the body and older people are more vulnerable. Because M1 receptor density is reduced by half in the elderly subjects, additional muscarinic antagonism could increase the risk of precipitating an accelerated decline in memory [7]. The use of drugs with anticholinergic activity is a biologically plausible and potentially modifiable risk factor for cognitive impairment. A number of clinical studies have provided empirical evidence of cognitive impairment associated specifically with benzodiazepines, amantadine, trihexphenidyl, oxybutynin, diphenhydramine [8-12]. Recent studies have measured serum levels of anticholinergic activities (SAA) in community-dwelling seniors and showed that high levels of SAA were significantly more likely to perform poorly on the MMSE [13].

Anticholinergic burden: considerations for older adults

“…An Australian cohort study estimated that 22–37% of adults aged 60 years or older were prescribed one or more anticholinergic medications . Depending on the study setting and method of measuring anticholinergic burden, studies conducted in other countries report a 21–50% prevalence of use of anticholinergic medications …”

Anticholinergic Drug Use and Mortality Among Residents of Long-Term Care Facilities: A Prospective Cohort Study

“…14,[20][21][22] The most frequently used anticholinergic drugs in previous studies have included anticholinergic antidepressants, hydroxyzine, and urinary antispasmodics. 18,22,23 The cumulative effect of taking 1 or more drugs with anticholinergic properties has been termed anticholinergic load. 24 Because of high rates of polypharmacy, older people may be particularly susceptible to experiencing a high anticholinergic load.…”

“…Use of anticholinergic drugs is higher among residents of aged care homes than among community‐dwelling older people. Determinants of anticholinergic drug use include older age, female sex, education level, and polypharmacy 14 , 20 – 22 . The most frequently used anticholinergic drugs in previous studies have included anticholinergic antidepressants, hydroxyzine, and urinary antispasmodics 18 , 22 , 23 …”

Barriers and facilitators to reducing anticholinergic burden from the perspectives of patients, their carers, and healthcare professionals: A protocol for qualitative evidence synthesis

“…Population surveys suggest that up to 50% of community dwelling older adults may be taking one or more medications with anticholinergic effects . The potential impact of anticholinergics on an individual is termed as anticholinergic burden (ACB), and concomitant use of multiple medications with anticholinergic properties has a cumulative effect .…”

“…wileyonlinelibrary.com/journal/jebm 227 anticholinergic effects. [4][5][6] The potential impact of anticholinergics on an individual is termed as anticholinergic burden (ACB), 2 and concomitant use of multiple medications with anticholinergic properties has a cumulative effect. 2,7 Several scales to assess ACB have been developed, such as the Anticholinergic Drug Scale, 8 Anticholinergic Cognitive Burden Scale 9 and the Anticholinergic Risk Scale.…”