Abstract
Anticholinergic burden has been widely studied in specific patient populations with specific conditions. However, the prevalence in the general population is poorly understood. This retrospective cross-sectional study was a nationwide database analysis of outpatient prescriptions of anticholinergic medications. The study was based on Slovenian health claims data of all outpatient prescriptions in 2018. Anticholinergic burden was evaluated using the Anticholinergic Cognitive Burden scale. Three age groups were analysed: children (≤18 years), adults (19–64 years) and older adults (≥65 years). Anticholinergic medications were prescribed to 29.8% of the participants; 7.6% were exposed to a clinically significant anticholinergic burden. The proportion of patients exposed to anticholinergic burden was highest in older adults (43.2%), followed by adults (25.8%) and children (20.7%). The most frequently prescribed medications with the highest anticholinergic activity were antipsychotics and medications for urinary diseases (42.8% and 40.2%, respectively). Medications with second highest activity were mostly antiepileptics (87.3%). Medications with possible anticholinergic activity included diverse therapeutic groups. Anticholinergic burden is highest in older adults but is also considerable among adults and children. Medications with anticholinergic activity belong to diverse therapeutic groups. Further research is needed on safe use of these medications in all age groups.
Highlights
Anticholinergic burden has been widely studied in specific patient populations with specific conditions
Two thirds of patients, who were exposed to anticholinergic burden, received prescriptions with anticholinergic cognitive burden (ACB) score 1 and one quarter of patients received prescriptions with ACB score 3
Patients presented as receiving medications with ACB score 1 only could have been prescribed multiple different medications with such score and still be exposed to a significant anticholinergic burden
Summary
Anticholinergic burden has been widely studied in specific patient populations with specific conditions. A recent study of over fifty-thousand patients, who were aged 55 years and above, offered compelling evidence of a link between anticholinergic medication exposure and dementia risk in later life[8]. These findings highlight the need to include children and adults below 65 years in studies of anticholinergic burden since there is currently a poor understanding of the true anticholinergic burden, along with its clinical consequences, across the entire population. This study evaluates the anticholinergic burden in the Slovenian population by analyzing health claim data of medication prescriptions issued to outpatients in 2018, making an important contribution to bridging current gaps in understanding. Anticholinergic burden (total ACB score) was calculated
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