Impact of Multiple Low-level Anticholinergic Medications on Anticholinergic Load of Community-dwelling Elderly with and Without Dementia

Overview

Journal Drugs Aging

Specialties Geriatrics
Pharmacology

Date 2015 Jan 9

PMID 25566958

Citations 21

Authors

Karen E Mate

Karen P Kerr

Dimity Pond

Evan J Williams

John Marley

Peter Disler

Henry Brodaty

Parker J Magin

Affiliations

Soon will be listed here.

Abstract

Background: Elderly people, particularly those with dementia, are sensitive to adverse anticholinergic drug effects. This study examines the prevalence of anticholinergic medication, and anticholinergic load and its predictors, in community-dwelling elderly patients (aged 75 years and older) in Australia.

Methods: A research nurse visited the home of each participant (n = 1,044), compiled a list of current medications, and assessed participants' cognitive status using a subsection of the revised Cambridge Examination for Mental Disorders of the Elderly (CAMCOG-R). Anticholinergic load was determined for each patient using the Anticholinergic Drug Scale (ADS).

Results: Multivariate analysis identified several patient factors that were associated with higher anticholinergic burden, including polypharmacy (i.e. taking five or more medications) (p < 0.001), increasing age (p = 0.018), CAMCOG-R dementia (p = 0.003), depression (p = 0.003), and lower physical quality of life (p < 0.001). The dementia group (n = 86) took a significantly higher number of medications (4.6 vs. 3.9; p = 0.04), and had a significantly higher anticholinergic load (1.5 vs. 0.8; p = 0.002) than those without dementia (n = 958). Approximately 60% of the dementia group and 40% of the non-dementia group were receiving at least one anticholinergic drug. This difference was due to the higher proportion of dementia patients taking level 1 (potentially anticholinergic) (p = 0.002) and level 3 (markedly anticholinergic) (p = 0.005) drugs.

Conclusions: There is considerable scope for the improvement of prescribing practices in the elderly, and particularly those with dementia. Importantly, level 1 anticholinergics have been identified as major contributors to the anticholinergic load in people with dementia. Longitudinal studies are required to determine the effects of increased and decreased anticholinergic load on cognitive function and other clinical outcomes for people with dementia.

Citing Articles

Investigation of the total anticholinergic load of reported anticholinergic drug-related adverse events using the Japanese adverse drug event report database: a retrospective pharmacovigilance study.

Kan Y, Doi M, Uesawa Y J Pharm Health Care Sci. 2025; 11(1):8.

PMID: 39885610 PMC: 11783805. DOI: 10.1186/s40780-025-00413-w.

Anticholinergic burden among in-patients: a cross-sectional study on prevalence, determinants, and impact on mortality in Ethiopia.

Gebreyohannes E, Taye W, Shibe B, Ayele E, Lee K, Mengistu S Ther Adv Drug Saf. 2024; 15:20420986241259624.

PMID: 38881539 PMC: 11179449. DOI: 10.1177/20420986241259624.

Cumulative Anticholinergic Burden and its Predictors among Older Adults with Alzheimer's Disease Initiating Cholinesterase Inhibitors.

Talwar A, Chatterjee S, Sherer J, Abughosh S, Johnson M, Aparasu R Drugs Aging. 2024; 41(4):339-355.

PMID: 38467994 DOI: 10.1007/s40266-024-01103-2.

Disentangling drug contributions: anticholinergic burden in older adults linked to individual medications: a cross-sectional population-based study.

Bhatkhande G, Choudhry N, Mahesri M, Haff N, Lauffenburger J BMC Geriatr. 2024; 24(1):44.

PMID: 38200457 PMC: 10782746. DOI: 10.1186/s12877-023-04640-4.

Development of a pharmacological evidence-based anticholinergic burden scale for medications commonly used in older adults.

Yamada S, Mochizuki M, Chimoto J, Futokoro R, Kagota S, Shinozuka K Geriatr Gerontol Int. 2023; 23(7):558-564.

PMID: 37313633 PMC: 11503540. DOI: 10.1111/ggi.14619.

References

TUNE L, Carr S, HOAG E, Cooper T . Anticholinergic effects of drugs commonly prescribed for the elderly: potential means for assessing risk of delirium. Am J Psychiatry. 1992; 149(10):1393-4. DOI: 10.1176/ajp.149.10.1393. View

Carnahan R, Lund B, Perry P, Chrischilles E . The concurrent use of anticholinergics and cholinesterase inhibitors: rare event or common practice?. J Am Geriatr Soc. 2004; 52(12):2082-7. DOI: 10.1111/j.1532-5415.2004.52563.x. View

Rudolph J, Salow M, Angelini M, McGlinchey R . The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008; 168(5):508-13. DOI: 10.1001/archinternmed.2007.106. View

Cancelli I, Gigli G, Piani A, Zanchettin B, Janes F, Rinaldi A . Drugs with anticholinergic properties as a risk factor for cognitive impairment in elderly people: a population-based study. J Clin Psychopharmacol. 2008; 28(6):654-9. DOI: 10.1097/JCP.0b013e31818ce849. View

Chan W, Setter S, Sclar D, Salek S, Corbett C, Henriksen A . The use of anticholinergic medications in homebound elderly patients with dementia. Consult Pharm. 2006; 21(5):391-9. DOI: 10.4140/tcp.n.2006.391. View

Lampela P, Lavikainen P, Garcia-Horsman J, Bell J, Huupponen R, Hartikainen S . Anticholinergic drug use, serum anticholinergic activity, and adverse drug events among older people: a population-based study. Drugs Aging. 2013; 30(5):321-30. DOI: 10.1007/s40266-013-0063-2. View

Magin P, Goode S, Pond D . GPs, medications and older people: A qualitative study of general practitioners' approaches to potentially inappropriate medications in older people. Australas J Ageing. 2014; 34(2):134-9. DOI: 10.1111/ajag.12150. View

Bhattacharya R, Chatterjee S, Carnahan R, Aparasu R . Prevalence and predictors of anticholinergic agents in elderly outpatients with dementia. Am J Geriatr Pharmacother. 2011; 9(6):434-41. DOI: 10.1016/j.amjopharm.2011.10.001. View

Tohgi H, Abe T, Kimura M, SAHEKI M, Takahashi S . Cerebrospinal fluid acetylcholine and choline in vascular dementia of Binswanger and multiple small infarct types as compared with Alzheimer-type dementia. J Neural Transm (Vienna). 1996; 103(10):1211-20. DOI: 10.1007/BF01271206. View

10.

Wang J, Zhao Z, Lin E, Zhao W, Qian X, Freire D . Unintended effects of cardiovascular drugs on the pathogenesis of Alzheimer's disease. PLoS One. 2013; 8(6):e65232. PMC: 3675203. DOI: 10.1371/journal.pone.0065232. View

11.

Pond C, Mate K, Phillips J, Stocks N, Magin P, Weaver N . Predictors of agreement between general practitioner detection of dementia and the revised Cambridge Cognitive Assessment (CAMCOG-R). Int Psychogeriatr. 2013; 25(10):1639-47. DOI: 10.1017/S1041610213000884. View

12.

Roe C, Anderson M, Spivack B . Use of anticholinergic medications by older adults with dementia. J Am Geriatr Soc. 2002; 50(5):836-42. DOI: 10.1046/j.1532-5415.2002.50208.x. View

13.

Gerretsen P, Pollock B . Drugs with anticholinergic properties: a current perspective on use and safety. Expert Opin Drug Saf. 2011; 10(5):751-65. DOI: 10.1517/14740338.2011.579899. View

14.

Sittironnarit G, Ames D, Bush A, Faux N, Flicker L, Foster J . Effects of anticholinergic drugs on cognitive function in older Australians: results from the AIBL study. Dement Geriatr Cogn Disord. 2011; 31(3):173-8. DOI: 10.1159/000325171. View

15.

Gnjidic D, Hilmer S, Hartikainen S, Tolppanen A, Taipale H, Koponen M . Impact of high risk drug use on hospitalization and mortality in older people with and without Alzheimer's disease: a national population cohort study. PLoS One. 2014; 9(1):e83224. PMC: 3890276. DOI: 10.1371/journal.pone.0083224. View

16.

Mannesse C, Derkx F, de Ridder M, Man in t Veld A, van der Cammen T . Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing. 2000; 29(1):35-9. DOI: 10.1093/ageing/29.1.35. View

17.

Jewart R, Green J, Lu C, Cellar J, Tune L . Cognitive, behavioral, and physiological changes in Alzheimer disease patients as a function of incontinence medications. Am J Geriatr Psychiatry. 2005; 13(4):324-8. DOI: 10.1176/appi.ajgp.13.4.324. View

18.

Ness J, Hoth A, Barnett M, Shorr R, Kaboli P . Anticholinergic medications in community-dwelling older veterans: prevalence of anticholinergic symptoms, symptom burden, and adverse drug events. Am J Geriatr Pharmacother. 2006; 4(1):42-51. DOI: 10.1016/j.amjopharm.2006.03.008. View

19.

Fick D, Agostini J, Inouye S . Delirium superimposed on dementia: a systematic review. J Am Geriatr Soc. 2002; 50(10):1723-32. DOI: 10.1046/j.1532-5415.2002.50468.x. View

20.

Bell J, Mezrani C, Blacker N, LeBlanc T, Frank O, Alderman C . Anticholinergic and sedative medicines - prescribing considerations for people with dementia. Aust Fam Physician. 2012; 41(1-2):45-9. View