Inpatient care for Alzheimer's disease (AD), often complicated by comorbidities, frequently involves polypharmacy (≥5 medications). The profile and cognitive consequences of sustained polypharmacy in these elderly inpatients require further investigation. To investigate the status of polypharmacy in elderly inpatients with AD and its correlation with three-year cognitive outcomes, so as to provide a basis for clinical optimization of medication regimens. This study was a retrospective propensity score matching (PSM) cohort study. 300 AD inpatients who were hospitalized from March 2022 to March 2025 were included. Patients were stratified into polypharmacy and non-polypharmacy groups according to their polypharmacy status. The primary outcome was the incidence of cognitive decline (MMSE decline ≥3 points) at 3 years. Secondary outcomes were the association of CDR progression, rate of decline in MoCA, incidence of falls, all-cause rehospitalization, all-cause mortality and anticholinergic drug burden with cognitive outcomes. After PSM, baseline characteristics were balanced (p>0.05). At the 3-year follow-up, the polypharmacy group had a significantly higher incidence of cognitive decline than the non-polypharmacy group (64.0% vs. 38.0%; RR=1.68, 95% CI: 1.33-2.13, p<0.001). Polypharmacy was also associated with faster CDR progression, a greater annual rate of MoCA decline and increased risks of falls (RR=1.82, p<0.01) and all-cause rehospitalization (RR=1.67, p<0.001). A high anticholinergic burden (ACB score ≥3) was identified as an independent predictor of cognitive decline (OR=2.5, 95%CI: 1.7-3.7, p<0.001). Our findings highlight polypharmacy as a key, modifiable risk for cognitive decline in AD, calling for structured medication management to mitigate this risk.

Translated article] Anticholinergic burden and its relationship with cognitive impairment in a neuropsychiatric unit.

To identify preliminary efficacy signals of anticholinergics, alpha-1 blockers, and their combination on bladder and renal function in boys with bladder dysfunction following posterior urethral valve (PUV) ablation, and to assess the feasibility of conducting a definitive randomized, controlled trial. In this single-center, prospective, randomized pilot trial boys under 12 years who had undergone cystoscopic valve ablation were randomized into three groups: anticholinergic therapy (Group I), alpha-1 blocker therapy (Group II), and combination therapy (Group III). The study was designed to detect within-group preliminary efficacy signals in urodynamic parameters following 6 months of pharmacotherapy. Secondary outcomes included changes in patient-reported symptom scores, renal function, and feasibility metrics. Between-group comparisons were performed as exploratory analyses. Feasibility and safety outcomes were analyzed in the intention-to-treat population, while efficacy analyses were conducted in participants who received intervention and had evaluable baseline and follow-up data. Thirty-five eligible patients were randomized (Group I, n = 12; Group II, n = 11; Group III, n = 12). and their clinical and biochemical analyses at baseline were recorded. Two deaths in Group II occurred prior to baseline urodynamics and pharmacotherapy initiation; efficacy analyses, therefore, included 33 patients (Group I, n = 12; Group II, n = 9; Group III, n = 12) with evaluable data. Urodynamic evaluation demonstrated favourable within-group trends: Group I showed a significant improvement in voided volume, while changes in voiding time, cystometric capacity (CC), static compliance, and maximum detrusor pressure (Pdetmax) were favourable but not uniformly statistically significant. Group II showed modest, favourable effects on Qmax, Time@Qmax, CC, and Pdetmax, with wide confidence intervals and no clear significant changes across most UDS measures. Group III demonstrated the most consistent favourable pattern, particularly for CC and Pdetmax, although most confidence intervals overlapped the null. Baseline-adjusted exploratory analyses did not demonstrate statistically significant between-group differences. Symptom scores improved across all groups. Feasibility outcomes were robust, with 81% recruitment, 91% urodynamic study completion, and 94% participant retention. This pilot trial demonstrates the feasibility of conducting urodynamic-guided pharmacotherapy studies in young boys with PUV-related bladder dysfunction. The observed within-group efficacy signals across all treatment arms-particularly with combination therapy-are hypothesis-generating and provide effect size and variability estimates to inform the design of a definitive randomized controlled trial.

Background: Pain is prevalent among critically ill patients and is frequently underrecognized due to sedation and mechanical ventilation. Opioids remain the primary analgesic therapy in the intensive care unit (ICU); however, opioid-related adverse effects have prompted increased adoption of multimodal analgesia strategies. Centrally acting skeletal muscle relaxants, including cyclobenzaprine and methocarbamol, are commonly used as adjuncts, yet data evaluating their anticholinergic adverse effects in critically ill populations are limited. Methods: The primary objective of this study is to determine the prevalence of anticholinergic adverse drug events (ADEs) associated with cyclobenzaprine and methocarbamol among ICU patients. Purpose: This retrospective cohort study evaluated adult patients (≥18 years) admitted to any ICU at a single academic medical center between January 1, 2023 and January 31, 2025, who received at least 1 dose of cyclobenzaprine or methocarbamol during ICU admission. The primary outcome was the prevalence of anticholinergic ADEs, identified through provider documentation and International Classification of Diseases, Tenth Revision (ICD-10) codes. Secondary outcomes included types of ADEs, dosing of the study drugs, and medication discontinuation rates. Results: Of 367 eligible patients, 260 were included in the final analysis. Cyclobenzaprine was administered to 112 patients (43%) and methocarbamol to 148 patients (57%). Potential anticholinergic ADEs were identified in 29 patients (14.4%) receiving cyclobenzaprine and 17 patients (10.8%) receiving methocarbamol. Among the 69 total ADEs, 55 (79%) prompted an intervention, most commonly pharmacologic therapy adjustments. Medication discontinuation due to ADEs was infrequent. Conclusions: Cyclobenzaprine and methocarbamol were associated with anticholinergic adverse effects in critically ill ICU patients, though this did not translate to medication discontinuation. These findings support the cautious use of centrally acting muscle relaxants as part of multimodal analgesia strategies. Pharmacists are uniquely positioned to evaluate and mitigate adverse drug effects in the critically ill.

Hyperhidrosis, or sweating beyond the physiological amount, can be either focal or generalized and sometimes runs in families. The prevalence of primary idiopathic hyperhidrosis is 2-5%. Secondary hyperhidrosis is associated with specific illnesses and medications. In this article, we discuss the diagnostic evaluation of hyperhidrosis and treatments for it, along with their efficacy and side effects. This narrative review is based on publications retrieved from the Medline and Cochrane databases with the search term "hyperhidrosis" and other specific terms relating to treatment. Expert recommendations and guidelines were considered as well. The diagnostic evaluation consists of a clinical history, a Minor (starch-iodine) test, gravimetry, and dynamic sudometry. There have been no more than a few high-quality published studies on specific interventions. Depending on the severity and symptom burden, aluminum chloride and anticholinergic drugs are used first, followed by botulinum toxin injections and subcutaneous curettage for axillary hyperhidrosis. These treatments reportedly bring about marked improvement in 60-70 % of patients; their side effects, depending on the particular treatment used, include local reactions such as itch, pain, and cutaneous irritation and anticholinergic effects such as dry mouth, mydriasis, urinary retention, and headache. Further therapeutic options are tap water iontophoresis; radiofrequency, focused ultrasound, and microwave treatment; systemically administered anticholinergic drugs; and thoracic or lumbar sympathectomy for palmar or plantar hyperhidrosis, respectively. A variety of methods can be used to relieve hyperhidrosis and improve these patients' quality of life. There have been no more than a few high-quality studies on their efficacy and long-term results.

Pediatric neurogenic lower urinary tract dysfunction (NLUTD) is commonly managed with anticholinergic agents and clean intermittent catheterization (CIC). However, treatment options are limited for patients who remain resistant to conventional therapy, particularly following spinal cord surgery. A 14-year-old boy with myelomeningocele underwent vertebral resection and spinal cord amputation. Despite CIC and solifenacin, he continued to experience daily urinary incontinence. 1 year postoperatively, his symptoms worsened and urinalysis became abnormal. Video-urodynamic study showed reduced bladder compliance and progression of bladder deformity. Vibegron 50 mg once daily was initiated. At 12 weeks, bladder capacity increased and compliance improved. Over 24 months, no urinary tract infections, incontinence episodes, or drug-related adverse events occurred. This case suggests that vibegron may be an effective, well-tolerated add-on therapy for pediatric patients with anticholinergic-resistant NLUTD after spinal cord surgery, improving bladder function and morphology while helping maintain quality of life.

Reversal With Sugammadex Is Associated With Early Return of Bowel Function After Right Colon Resections.

The FUTURE study (International Standard Randomised Controlled Trial Number ISRCTN63268739) has reignited debate on the utility of urodynamics, this time in women presenting with refractory overactive bladder (OAB) symptoms [1]. The study concluded that incorporating urodynamics into the diagnostic work-up does not enhance clinical outcomes. This conclusion has sparked significant criticism and controversy within the urological community, underscoring the need for critical evaluation of the pathophysiology and management of OAB in women, clinical utility of urodynamics, and the generalisability of the FUTURE study's findings [2, 3]. Over the past three decades, OAB treatment options have expanded dramatically, culminating in a strict stepwise management algorithm. However, this approach has not proved to be patient centred. Many patients find the process protracted and demotivating. Moreover, the prevailing philosophy of transitioning from least invasive to most invasive treatments may be flawed. Concerns about the long-term cognitive effects of anticholinergics raise questions about their safety compared to more invasive options, such as intradetrusor injections of botulinum toxin A or sacral neuromodulation, and the alternative pharmacotherapy, beta-3 agonists, has notably poor adherence rates. Recent updates to the AUA/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) guidelines (https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder) recommend moving away from step therapy in favour of shared decision-making and personalised treatment. Implicit in this shift toward patient-centred care in OAB management is the expectation that both clinicians and patients are equipped with adequate information to choose a treatment that maximises the likelihood of success while minimising the risk of complications. Urodynamics has long been recognised as the ‘gold standard’ for objectively diagnosing lower urinary tract (LUT) dysfunction. Furthermore, women with similar OAB symptoms can exhibit vastly different underlying dysfunctions, highlighting the necessity of urodynamics for guiding treatment decisions. One study identified BOO in 19% of women with OAB [4], for whom empirical treatments like anticholinergics or botulinum toxin would have adverse effects. Detrusor overactivity (DO) is commonly presumed to be the cause of OAB symptoms, and some argue that its presence is predictable. However, standard urodynamics demonstrates DO in only about 40–60% of patients with OAB [5]. This may be because the DO is latent (in which case ambulatory urodynamics is indicated) or DO is not the primary cause of the OAB symptoms. Again, this insight is key in determining the likely benefit of treatment options. Urodynamic parameters have not only been demonstrated to predict outcomes but also to guide choice of second-line interventions by matching their primary mechanism of action to the specific LUT dysfunction demonstrated. An under-recognised but invaluable role of urodynamic testing is its ability to support shared decision-making. By increasing diagnostic certainty and revealing underlying LUT physiology, urodynamics empowers clinicians to explain clearly why specific treatments may or may not be effective and to estimate the likelihood of benefit or adverse effects. Integrating this physiological evidence with patient preferences, symptom burden, and risk tolerance enables more informed, transparent, pragmatic and personalised treatment decisions. The FUTURE study [1] has prompted essential discussions about the role of urodynamics in the management of female OAB. The value of urodynamics in characterising LUT function to allow tailored management is undeniable. As the provision of urodynamics is often limited, the motivation to prioritise which patients would benefit the most from the test is understandable. However, limited access or funding should not be reasons to downplay its overt clinical utility, which translates into five meaningful benefits for healthcare practice and the lives of our patients (Fig. 1). As the field of urology continues to evolve, it is crucial to challenge the perception that randomised controlled trials, which assess the value of a diagnostic test with the outcomes of an intervention at a population level, represent the apex of evidence, particularly in the context of heterogeneous syndromes like OAB. A nuanced understanding of each patient's unique presentation will ultimately lead to more effective and personalised treatment strategies and fully informed shared decision-making. No conflicts exist.

Anticholinergic burden scales are widely used to guide medication review in older adults, yet their ability to predict clinically important adverse outcomes remains uncertain, as most evidence is based on associations rather than validated risk prediction. In the absence of a gold standard, the clinical value of these scales depends on whether they can discriminate between individuals at risk and provide accurate absolute risk estimates. To compare the predictive performance of six anticholinergic burden scales for hospitalisation/emergency department (ED) visits related to anticholinergic adverse effects, assess internal and temporal validation of cognitive impairment models across scales, and examine the risk gradient across increasing anticholinergic burden levels for cognitive impairment across scales. A retrospective cohort study using linked population-level administrative health data of adults aged ≥ 65 years in Western Australia (2015-2019). Development cohorts were from 2015-16 (N = 323,682) and 2016-17 (N = 334,304), and the temporal validation cohort was from 2017-18 (N = 330,684). Six anticholinergic burden scales were calculated annually. Logistic regression models with common predictor structure including demographic and clinical predictors were used to predict any hospitalisation/ED visit related to anticholinergic adverse events (falls/fractures/dizziness, cognitive impairment, or constipation/urinary retention). Model performance was assessed using the c-statistic, calibration slope, and Brier score. Cognitive impairment models were further evaluated using bootstrap internal validation (200 replications), temporal validation, and predicted risk estimation across exposure deciles. Across initial model comparisons, Korean Anticholinergic Burden Scale (KABS) showed the highest c-statistics for each outcome, although between-scale differences were small. Cognitive impairment showed the highest discrimination across scales and was selected for further validation. In temporal validation, c-statistics for cognitive impairment ranged from 0.795 to 0.806, with the highest value observed for KABS, and calibration slopes ranging from 1.024 to 1.032 across scales. Predicted risk of cognitive impairment increased across exposure deciles for all scales, with the highest-decile risk ranging from 5.27% for TSDD-SAMS to 7.58% for KABS. KABS showed slightly higher and more consistent predictive performance than the other scales, particularly for cognitive impairment, although between-scale differences were modest. Presenting validated absolute risk estimates across exposure groups may improve clinical interpretability and support risk stratification, but wider validation and clinical judgement remain essential before routine use.

Epidemiological data on patients with uncontrolled severe bronchial asthma (SA) in the Russian Federation are limited due to the lack of a unified system for routine monitoring of these patients. The aim of this study was to describe the clinical and demographic indicators and characterize the routine treatment profile of Russian patients with uncontrolled SA who are not receiving treatment with biological agents. Methods. This multicenter, observational, cross-sectional study included patients aged 18 years or older diagnosed with uncontrolled SA. Patients received drug therapy, were followed by a pulmonologist or allergist, and had access to follow-up data for 52 weeks or more. As part of the interim analysis, we summarized the demographic characteristics, medical history, and the results of laboratory and instrumental examination of patients ( n = 691: 498 (72.1%) - female; mean age of participants - 56.3 ± 13.6 years). Different types of SA therapy, events of healthcare resource utilization and severe exacerbations during 52 weeks preceding enrollment in the study were recorded. Results. It was established that the median duration of asthma at inclusion was 13 years. Over the previous 3 months, the most frequently used background therapy in 335 (48.5%) patients was a triple combination of inhaled corticosteroid + long-acting e2-agonist + long-acting anticholinergic drug. The most common approach to relief the attacks in 318 (46.0%) patients was monotherapy with a short-acting e 2 -agonist. The proportions of patients with 1, 2, and at least 3 severe asthma exacerbations were 47.2%, 12.9%, and 10.1%, respectively. At least one unscheduled outpatient visit, at least one emergency department visit/urgent care call, and at least one hospitalization in the previous 52 weeks were recorded in 317 (45.9%), 103 (14.9%), and 438 (63.4%) patients, respectively. Over 12 months, 79 cases of corticosteroid use were noted in 62 (9.0%) patients. 140 (20.3%) participants were prescribed biologic asthma medications at the enrollment visit. Conclusion. Patients with uncontrolled SA are characterized by frequent development of severe exacerbations, which create a significant burden on the healthcare system. The identified characteristics of medical care for such patients can serve as a basis for optimizing existing treatment approaches and improving disease outcomes.

Background/Objectives: Constipation is a common gastrointestinal problem in older adults and is associated with reduced quality of life, functional decline, frailty, and an increased risk of delirium and cognitive impairment. Its pathogenesis is multifactorial, involving age-related changes in gastrointestinal motility, neural regulation, comorbidities, and polypharmacy. However, this condition has traditionally been regarded as a localized gastrointestinal disorder, which may not fully reflect its systemic clinical significance in older populations. While prior narrative reviews have described multifactorial contributors to constipation, none have formally applied a geriatric syndrome framework to integrate these dimensions. This review proposes a three-criterion operational definition-multifactorial pathogenesis, association with functional decline and frailty, and contribution to adverse systemic outcomes-to characterize constipation in older adults as a "systemic geriatric syndrome," and evaluates available evidence against each criterion. Methods: A narrative literature search was conducted using PubMed to identify relevant studies published between 1 January 2023, and 31 December 2025. MeSH terms included "Constipation" [Major Topic] and "Aged" [MeSH Terms]. Eligible articles included English-language original studies, systematic reviews, and clinical or epidemiological studies involving individuals aged ≥65 years. Results: Diagnosis in older adults is often complicated by secondary causes, including medications and neurological disorders, as well as atypical symptom presentations in individuals with cognitive impairment. Key pathophysiological mechanisms include reductions in interstitial cells of Cajal, impaired smooth muscle contractility, dysfunction of the enteric and autonomic nervous systems, and gut microbiota dysbiosis, which may promote chronic low-grade inflammation. Major contributing factors include physical inactivity, sarcopenia, dehydration, inappropriate defecation posture, and polypharmacy, particularly opioids and anticholinergic agents. Importantly, these factors interact through the brain-gut-microbiota axis, contributing not only to gastrointestinal dysfunction but also to systemic outcomes such as frailty, cognitive decline, and increased healthcare burden, thereby supporting a multidimensional disease framework. Conclusions: The available evidence collectively supports the plausibility of framing constipation in older adults as a systemic geriatric syndrome, though formal validation of this classification requires further longitudinal and mechanistic research. Comprehensive and individualized management strategies, extending beyond simple laxative use, are essential to reduce complications and preserve functional health in aging populations. Further studies are required to validate this framework.

Topical anticholinergic agents are non-invasive treatment options for primary axillary hyperhidrosis (PAH). Sofpironium bromide was recently approved by the US Food and Drug Administration (FDA). A comprehensive evaluation of the efficacy and safety of available topical anticholinergics may inform clinical practice. To assess the efficacy and safety of topical anticholinergic therapies for PAH through systematic review and meta-analysis of randomized controlled trials (RCTs). Five databases were searched on September 9, 2024. Primary outcomes included a ≥2-point improvement in the Hyperhidrosis Disease Severity Scale (HDSS) and ≥50% reduction in gravimetric sweat production (GSP). Secondary outcomes included subjective symptom improvement and objective sweat reduction. Safety outcomes included treatment-emergent adverse events (TEAEs), anticholinergic-related adverse events, and local application site reactions. The review protocol was registered in PROSPERO (CRD42024583376). Eight RCTs (n = 1921) that evaluated glycopyrronium, sofpironium bromide, and umeclidinium were included. Topical agents significantly outperformed placebos for HDSS ≥2-point improvement (risk ratio [RR]: 2.40; 95% confidence interval [CI]: 2.01-2.86) and GSP ≥50% reduction (RR: 1.43; 95% CI: 1.21-1.70). Sofpironium was the most effective HDSS treatment, whereas glycopyrronium showed highest efficacy against GSP. Topical agents were associated with increased risk of TEAEs (RR: 1.43; 95% CI: 1.14-1.79), with sofpironium associated with highest risk of dry mouth and glycopyrronium with highest risks for mydriasis and constipation. Topical anticholinergic agents are effective for PAH treatment, with distinct efficacy and safety profiles. Although the available evidence is limited by the small number of trials, short follow-up durations, and heterogeneity in outcome reporting, these findings support the role of topical anticholinergic therapy as an effective non-invasive option for PAH.

Medication history from Japanese pharmacies is potentially rich in useful information regarding drug-related events in diverse populations; however, this information has rarely been utilized as real-world data. This study aimed to evaluate the feasibility of using medication history as real-world data to assess associations between anticholinergic medications for overactive bladder (OAB) and increased risk of dementia. A retrospective prevalent-user cohort study was performed to analyze medication history using a logistic regression model. The primary exposure was anticholinergic drug use for OAB (vs. beta-3 agonists only). The risk associated with each specific anticholinergic drug was also analyzed. Adjustments included age, sex, comorbidities (diabetes, hyperlipidemia, and hypertension), and psychotropic drug use. OAB anticholinergics and age were significant predictors. The adjusted odds ratio (OR) and 95% confidence interval (CI) for OAB anticholinergics were 1.53 (95% CI: 1.10-2.14, p = 0.0110), and those for age were 1.07 (95% CI: 1.04-1.09, p < 0.0001). Among individual OAB anticholinergics, the ORs for oxybutynin (4.53; 95% CI: 2.18-9.42, p < 0.0001) and tolterodine (5.64; 95% CI: 2.42-13.17, p < 0.0001) were significant, whereas ORs for other OAB anticholinergics were not. These findings suggest the potential to identify agents with lower dementia risk. In conclusion, analysis in this prevalent-user cohort study using medication history data showed a significant association between OAB anticholinergic use and increased dementia risk, with variation by drug. These results support the feasibility of utilizing medication history as real-world data for pharmacovigilance.

The evaluation and management of lower urinary symptoms (LUTS) experienced in the immediate post-operative period after benign prostatic obstruction surgery (BPO), remain unclear. Aim of our study is to systematically report the evidence on management of post-operative transient urinary symptoms after BPO surgery. A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist (PRISMA). PubMed, Embase, Scopus and Cochrane databases were searched up to March 2025. Studies evaluating pharmacotherapy, phytotherapy and/or physical treatment for post-operative transient LUTS in men aged were evaluated. Only randomized clinical trials (RCTs) were included. Overall, nine RCTs were included. Among the surgical techniques investigated, most data were available for transurethral resection of the prostate. The methods used to assess post-operative LUTS, as well as the timing of evaluation, varied considerably across studies. The most commonly submitted questionnaire was the International Prostate Symptom Score, and the most frequently performed diagnostic tool was uroflowmetry. Anticholinergic drugs seems to have the greatest efficacy in improving post-operative LUTS, even if the level of evidence is low. In contrast, alpha-blockers did not appear to offer significant additional benefits in this setting of patients. Phytocomplexes (Graminex G63, Curcumin complexes) were effective in improving patients' quality of life (QoL) after BPO surgery. Pelvic floor muscle exercises (PFME) also demonstrated a reduction in symptom-related bother. Current strategies for evaluating and managing transient postoperative LUTS are heterogeneous, and available evidence remains limited. Anticholinergic agents and phytotherapeutic compounds are among the most commonly prescribed treatments, though their efficacy is suboptimal. High-quality randomized trials are needed to provide robust clinical recommendations.

Diagnostic subtype has been suggested as a determinant of inequity for people with dementia; its impact on primary care provision is underexplored. This study investigated the association between dementia subtype and likelihood of receiving guideline-consistent primary care. Retrospective cohort study using Clinical Practice Research Datalink (Aurum) database, 1.1.2006-30.06.2024. We examined potential inequity with eight dementia subtypes: Alzheimer's disease (AD), Lewy body dementia (LBD), vascular, frontotemporal, unspecified, other and two mixed categories. Six outcomes were examined: care plan or medication review (both within 24months of index) and four indicators of potentially inappropriate prescribing (PIP) (high anti-cholinergic burden drugs, z-drugs, benzodiazepines and anti-psychotics). Cox-regression models were used, adjusting for: age, sex, comorbidities, deprivation and ethnicity. A total of 571 663 people were included and 72.1% received a care plan; 79.4% received a medication review within 24months. Compared to AD: people with mixed dementias were more likely to receive a care plan [hazard ratio (HR) 1.29, 95% confidence interval (CI) 1.26-1.32 for mixed including AD/LBD, HR 1.37, 1.32-1.43 for mixed non-AD/LBD]. All other subtypes were less likely to receive a care plan. Individuals with mixed AD/LBD (HR 1.28, 1.26-1.32), mixed non-AD/LBD (HR 1.35, 1.26-1.45), vascular (HR 1.05, CI 1.04-1.07), LBD (HR 1.02, 1.01-1.04) and unspecified (HR 1.02, 1.01-1.03) were more likely to receive medication reviews. Compared to AD, all other subtypes were more likely to experience PIP across all four indicators. We found greater likelihood of PIP in people with non-AD dementias, a novel finding. Further research is needed, especially with new AD drugs potentially widening disparities.

Background: Anticholinergic medications are among the most widely prescribed drug classes in older adults, yet their cumulative burden poses substantial risks for cognitive decline, falls, and functional impairment. The Anticholinergic Cognitive Burden (ACB) scale provides a validated framework for quantifying this risk, with scores ≥3 indicating clinically significant burden. Objective: This quality improvement project (QIP) aimed to identify patients aged ≥65 years with an ACB score ≥3 in a primary care setting and to implement structured medication review interventions, including de-prescribing, switching, or dose adjustment, to reduce anticholinergic burden. Methods: A cross-sectional quality improvement design was employed over a six-month period (January–June 2024) in a GP practice in the United Kingdom. All registered patients aged ≥65 years were systematically screened using the ACB scale. Patients with a total ACB score ≥3 underwent structured medication reviews. Interventions included de-prescribing, therapeutic switching to alternatives with lower anticholinergic activity, and dose reduction. Pre- and post-intervention ACB scores were compared. Results: Of 120 patients screened, 98 were aged ≥65 years and 62 (63.3%) had an ACB score ≥3. The most prevalent anticholinergic agents were amitriptyline (29.0%), oxybutynin (22.6%), and tolterodine (19.4%). Following intervention, the mean ACB score decreased from 4.7 ± 1.1 to 2.9 ± 1.0 (p&lt;0.001), the proportion of patients with ACB ≥3 reduced from 63.3% to 42.9%, and Mini-Mental State Examination scores showed modest improvement. Conclusion: Structured, ACB-guided medication reviews in older primary care patients are feasible and effective in reducing anticholinergic burden. Embedding systematic pharmacological review within routine geriatric care can meaningfully protect cognitive function and reduce fall risk in this vulnerable population.

Chronic effects of traumatic brain injury and the impact of biperiden treatment in a male rat model.

BackgroundAnticholinergic medications carry increased risk of worsening cognition, particularly in patients with dementia.ObjectiveCognitive and functional scores of patients were compared at 1-year follow up after cessation of prior anticholinergic medications to those who were not taking anticholinergics at baseline to assess whether prior anticholinergic use affected dementia prognosis in memory clinic patients.MethodsLongitudinal data from 578 consecutive patients with diagnoses including Alzheimer's disease (AD), frontotemporal and vascular dementia, Lewy body dementia, mild cognitive impairment and dementia due to non-AD etiologies compared patients taking anticholinergic drugs to those taking none at intake. Anticholinergic drugs were discontinued in all patients at initial visit. Mini-Mental Status Examination (MMSE) and Functional Activities Questionnaire (FAQ) were administered at intake and 1-year follow up.ResultsBetween the no-anticholinergic and anticholinergic groups, MMSE at baseline did not significantly differ when the entire sample was compared. In addition, MMSE score change between baseline and follow-up did not significantly differ. Similarly, no significant differences were observed between groups in FAQ at baseline or in FAQ change between timepoints. Subgroup analysis of only those with AD yielded statistically significant differences in initial MMSE. However, these groups had statistically similar follow-up MMSE. Although initial FAQ scores were similar, there were significant differences in follow-up FAQ in patients with AD.ConclusionsFindings suggest that patients with AD presenting on anticholinergic medications may do worse cognitively and functionally than those who were never on anticholinergics despite baseline discontinuation. Anticholinergic medication use in older adults should be approached cautiously.

Association between anticholinergic burden scales and recurrent falls in independently living older adults: a cross-sectional study.

The U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DOD) updated the 2019 joint clinical practice guideline (CPG) for the primary care management of asthma. This synopsis provides primary care providers with a summary of the updated 2025 recommendations regarding evaluation and management of veterans and military members with asthma. In 2024, the VA/DOD convened a guideline work group (WG), including clinical stakeholders, to update the joint VA/DOD guideline and conformed to the National Academy of Medicine's tenets for trustworthy CPGs. The WG drafted 12 key questions, reviewed systematically identified literature (20 July 2018 through 15 May 2024), evaluated the evidence, created algorithms, and advanced 21 evidence-based recommendations in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The WG strongly recommended inhaled corticosteroids (ICS) and streamlined management of asthma by suggesting a combination of ICS and rapid-onset long-acting β-agonist as both reliever and controller agents and step-up therapy by increasing ICS and/or adding long-acting anticholinergic agents. The WG also supported the management of symptomatic gastroesophageal reflux disease and obesity for better control of asthma. The WG suggested against the use of indoor air filtration devices. Finally, the WG outlined decision points for referral to a subspecialist.