Abstract
PurposeThe Drug Burden Index (DBI) is a tool to quantify the anticholinergic and sedative load of drugs. Establishing functional correlates of the DBI could optimize drug prescribing in patients with dementia. In this cross-sectional study, we determined the relationship between DBI and cognitive and physical functions in a sample of patients with dementia.MethodsUsing performance-based tests, we measured physical and cognitive functions in 140 nursing home patients aged over 70 with all-cause dementia. We also determined anticholinergic DBI (AChDBI) and sedative DBI (SDBI) separately and in combination as total drug burden (TDB).ResultsNearly one half of patients (48%) used at least one DBI-contributing drug. In 33% of the patients, drug burden was moderate (0 < TDB < 1) whereas in 15%, drug burden was high (TDB ≥ 1). Multivariate models yielded no associations between TDB, AChDBI, and SDBI, and physical or cognitive function (all p > 0.05).ConclusionsA lack of association between drug burden and physical or cognitive function in this sample of patients with dementia could imply that drug prescribing is more optimal for patients with dementia compared with healthy older populations. However, such an interpretation of the data warrants scrutiny as several dementia-related factors may confound the results of the study.
Highlights
With the world population progressively growing older, the number of older adults with dementia increases
What this study adds We found that Drug Burden Index (DBI) is unrelated to cognitive and physical functions in a sample of 140 nursing home patients with dementia
The total number of drugs did not correlate with total drug burden (TDB), anticholinergic DBI (AChDBI), or sedative DBI (SDBI)
Summary
With the world population progressively growing older, the number of older adults with dementia increases. The prevalence of comorbidities among patients with dementia is high [3]. 43 to 92% of dementia patients are exposed to polypharmacy, i.e., the concurrent use of five or more medications from different drug categories [4,5,6,7], which can result in serious adverse drug reactions (ADRs) such as cognitive impairment, functional decline, and an increase in risk of falls and fractures [8, 9]. Even though anticholinergic and sedative psychotropic drugs have especially high risks to cause adverse effects, it is estimated that 23 to 47% of dementia patients take at least one anticholinergic or sedative drug [11,12,13]
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