A - 97 Anticholinergic Burden Scales Are Not Created Equal: Differential Relationships to Cognition in Parkinson's Disease.

Abstract

Cognitive changes are common in Parkinson's disease (PD). While previous research suggests greater anticholinergic medication use relates to worse broad cognition in PD, its domain-specific relationships remain unknown. This study compared three anticholinergic scales to examine their relationship to worse memory and executive function in individuals with PD. Participants included 493 non-demented individuals with PD (mean age = 65.74, SD = 9.04; mean education = 15.0, SD = 2.79; 72% male; 94% White (non-Hispanic)) from a movement disorders specialty clinic. Medications were identified via chart review. Each medication was scored (0-3) and summed using three scales: Anticholinergic Risk Scale (ARS), Anticholinergic Drug Scale (ADS), Anticholinergic Cognitive Burden Scale (ACBS). Cognitive composites averaged normative z-scores: Executive Function (EF; Trails B, Stroop Color-Word, Letter Fluency) and Memory (HVLT-R and WMS-III Logical Memory delayed recalls). Analyses included Bonferroni-adjusted, bootstrapped Spearman correlations. The three scales were significantly related, but with only fair agreement (Kendall's W(2) = 0.37, p < 0.001). Worse memory related to higher cholinergic burden on only the ACBS (r = -0.10, p = 0.02). Exploratory analyses indicated sex differences in the relationship between cognition and anticholinergic burden. For men, worse memory related to higher scores on both the ACBS (r = -0.11, p = 0.04) and ARS (r = -0.11, p = 0.045). For women, higher ACBS scores related to worse EF (r = -0.18, p = 0.03), whereas higher ADS scores related to worse memory and EF (r = -0.18, p = 0.04; r = -0.26, p = 0.002). Anticholinergic burden scales differentially related to cognitive performance in PD, with only ACBS showing a significant relationship to memory. Exploratory analyses suggest that scales may have differential relationships to memory and EF in men and women.