Reduction of anticholinergic cognitive burden (ACB) in primary care using a clinical decision‐support software (CDSS) platform

Abstract

AbstractBackgroundMany oral medications can induce a level of “brain fog,” known as Anticholinergic Cognitive Burden. This cognitive burden can be quantified; a consensus on the scoring, from 0 (best) to 3 (worst), has been developed. Drugs with non‐zero scores span pharmacological classes, including antidepressants, antipsychotics, and urological treatments. Higher ACB scores have been correlated with lower performance in cognitive assessments; every 3 points of ACB score may reduce MMSE results by one. This burden confounds cognitive status (i.e., are medications causing observed cognitive impairment?). Recently, some ACB drugs have also been correlated with future dementia incidence.MethodsuMETHOD Health has developed a CDSS platform to address dementia, MCI, and mild AD through the creation of personalized, multidomain treatment plans. The software sums the ACB score across all the medications in someone’s active medication list, showing their impact visually in the generated treatment plan. Drawing from multiple published sources, the platform evaluates 314 generic ACB drugs (including combination drugs). The treatment plans recommend alternatives for each drug with an ACB score of 2 or 3 (called definite anticholinergics). 2,566 individuals aged 65 to 102 comprise the population analyzed here.ResultsIndividuals were an average of 9.5 medications (stdev: 6.5). 75.1% were on anticholinergic medications (mean: 3.4, stdev: 2.7). Had the 350 patients with an ACB score of 5 or more followed the platform recommendations, their average ACB score may have been reduced from 6.94 to 3.3, potentially improving their cognitive assessment performance. Females were taking more anticholinergic drugs than males (2.7 vs. 2.2) and had a higher average ACB score (3.7 vs. 2.7).ConclusionsACB drugs are confounders of cognitive decline, and some are contributors to it. Managing medications is a complex task, the complexity of which increases when dealing with an older population who are not only on more medications, but also have existing comorbidities. The CDSS platform identifies many polypharmacy problems; taking the recommended alternative medications to treat the same comorbidities could lower their ACB score significantly. Clinical professionals should consider ACB analysis part of every visit with their older patients, especially those evincing cognitive decline.