Abstract
BackgroundDrugs with anticholinergic properties may be associated with various adverse clinical effects. The relationship between the anticholinergic (AC) burden and functional, global cognitive performance and behavior disturbances was assessed among elderly patients.MethodsA cross-sectional study was conducted between January 2012 and June 2014 in a memory clinic among outpatients living at home and with subjective cognitive decline (SCD) or neurocognitive disorders (NCD). The AC burden was measured using the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden (ACB), Chew’s score, Han’s score, and the number of drugs with AC activity. Functional, cognitive performance and behavior disturbances were assessed using the Instrumental Activities of Daily Living (IADL) scale (IADL), the Mini Mental State Examination (MMSE), and the Neuropsychiatric Inventory (NPI).ResultsAmong 473 included patients, 46.3% were at major NCD. Patients took on average 5.3 ± 2.6 drugs. MMSE was lower when Han’s score (p = 0.04) and number of AC drugs were higher (p < 0.001). IADL was lower when AC burden was higher, whatever the AC measurement. NPI was higher when ACB, Han’s score, and number of AC drugs were higher. After adjustment, all AC scores remained associated with IADL, while Han’s score and number of drugs with AC remained associated with the MMSE.ConclusionsIn patients with SCD or NCD, AC burden is associated with lower functional score, whereas the cross-sectional association between AC burden and cognitive performance or behavioral disturbance varies according to AC scores. Particular attention should be paid when prescribing drugs with AC properties, especially among patients with memory complaints.
Highlights
Drugs with anticholinergic properties may be associated with various adverse clinical effects
Most of the studies have been conducted among elderly people in primary prevention, whereas studies assessing relationships between AC and health outcomes in ambulatory patients with subjective cognitive decline (SCD), mild or major neurocognitive disorders (NCD), known as mild cognitive impairment (MCI) or dementia, including Alzheimer’s disease or related diseases (ADRD) remain scarce [16, 17]
The drug management of behavioral disorders associated with NCD includes the prescription of psychotropic drugs, this prescription may increase the adverse events associated with AC exposure among these patients which makes it challenging for physicians [18]
Summary
Drugs with anticholinergic properties may be associated with various adverse clinical effects. Drugs with AC activity may be associated with various adverse clinical effects including falls, delirium, cognitive and physical function impairment, and all-cause mortality [2,3,4,5,6,7,8]. Most of the studies have been conducted among elderly people in primary prevention, whereas studies assessing relationships between AC and health outcomes in ambulatory patients with subjective cognitive decline (SCD), mild or major neurocognitive disorders (NCD), known as MCI or dementia, including Alzheimer’s disease or related diseases (ADRD) remain scarce [16, 17]. The adverse effects of AC drugs may be higher among patients with NCD, especially the central anticholinergic adverse effects These increased effects might be due to physiological changes, modifications in drug metabolism, pharmacodynamics, and pharmacokinetics that are observed among aging patients with cognitive impairment
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