The Predictive Value of Anticholinergic Burden Measures in Relation to Cognitive Impairment in Older Chronic Complex Patients

Overview

Journal J Clin Med

Specialty General Medicine

Date 2022 Jun 24

PMID 35743428

Authors

Angela Tristancho-Perez

Angela Villalba-Moreno

Maria Dolores Lopez-Malo de Molina

Bernardo Santos-Ramos

Susana Sanchez-Fidalgo

Affiliations

Soon will be listed here.

Abstract

Anticholinergic burden (AB) is related to cognitive impairment (CI) and older complex chronic patients (OCCP) are more susceptible. Our objective was to evaluate the predictive value of ten anticholinergic scales to predict a potential CI due to anticholinergic pharmacotherapy in OCCP. An eight-month longitudinal multicentre study was carried out in a cohort of OCCP, in treatment with at least one anticholinergic drug and whose cognition status had been evaluated by Pfeiffer test twice for a period of 6-15 months. CI was considered when the Pfeiffer test increased 2 or more points. AB was detected using ten scales included on the Anticholinergic Burden Calculator. An ROC curve analysis was performed to assess the discriminative capacity of the scales to predict a potential CI and the cut-off point of AB that obtains better validity indicators. 415 patients were included (60.2% female, median age of 85 years (IQR = 11)). 190 patients (45.8%) manifested CI. Only the DBI (Drug Burden Index) showed statistically significant differences in the median AB between patients without CI and with CI (0.5 (1.00) vs. 0.67 (0.65), = 0.006). At the ROC curve analysis, statistically significant values were obtained only with the DBI (AUC: 0.578 (0.523-0.633), = 0.006). The cut-off point with the greatest validity selected for the DBI was an AB of 0.41 (moderate risk) (sensitivity = 81%, specificity = 36%, PPV = 51%). The DBI is the scale with the greatest discriminatory power to detect OCCP at risk of CI and the best cut-off point is a load value of 0.41.

References

Alexander M, Perera G, Ford L, Arrighi H, Foskett N, Debove C . Age-Stratified Prevalence of Mild Cognitive Impairment and Dementia in European Populations: A Systematic Review. J Alzheimers Dis. 2015; 48(2):355-9. DOI: 10.3233/JAD-150168. View

Kashyap M, Belleville S, Mulsant B, Hilmer S, Paquette A, Tu L . Methodological challenges in determining longitudinal associations between anticholinergic drug use and incident cognitive decline. J Am Geriatr Soc. 2014; 62(2):336-41. PMC: 4233958. DOI: 10.1111/jgs.12632. View

Carnahan R, Lund B, Perry P, Pollock B, Culp K . The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol. 2006; 46(12):1481-6. DOI: 10.1177/0091270006292126. View

Nishtala P, Salahudeen M, Hilmer S . Anticholinergics: theoretical and clinical overview. Expert Opin Drug Saf. 2016; 15(6):753-68. DOI: 10.1517/14740338.2016.1165664. 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

Ehrt U, Broich K, Larsen J, Ballard C, Aarsland D . Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study. J Neurol Neurosurg Psychiatry. 2009; 81(2):160-5. DOI: 10.1136/jnnp.2009.186239. View

Hilmer S, Mager D, Simonsick E, Cao Y, Ling S, Windham B . A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007; 167(8):781-7. DOI: 10.1001/archinte.167.8.781. View

Duran C, Azermai M, Vander Stichele R . Systematic review of anticholinergic risk scales in older adults. Eur J Clin Pharmacol. 2013; 69(7):1485-96. DOI: 10.1007/s00228-013-1499-3. View

Lavrador M, Castel-Branco M, Cabral A, Verissimo M, Figueiredo I, Fernandez-Llimos F . Association between anticholinergic burden and anticholinergic adverse outcomes in the elderly: Pharmacological basis of their predictive value for adverse outcomes. Pharmacol Res. 2020; 163:105306. DOI: 10.1016/j.phrs.2020.105306. View

10.

Villalba-Moreno A, Alfaro-Lara E, Rodriguez-Perez A, Banez-Toro D, Sanchez-Fidalgo S, Perez-Guerrero M . Association Between Drug Burden Index and Functional and Cognitive Function in Patients with Multimorbidity. Curr Pharm Des. 2018; 24(28):3384-3391. DOI: 10.2174/1381612824666180327154239. View

11.

Han L, Agostini J, Allore H . Cumulative anticholinergic exposure is associated with poor memory and executive function in older men. J Am Geriatr Soc. 2008; 56(12):2203-10. PMC: 3952110. DOI: 10.1111/j.1532-5415.2008.02009.x. View

12.

Campbell N, Perkins A, Bradt P, Perk S, Wielage R, Boustani M . Association of Anticholinergic Burden with Cognitive Impairment and Health Care Utilization Among a Diverse Ambulatory Older Adult Population. Pharmacotherapy. 2016; 36(11):1123-1131. PMC: 5362375. DOI: 10.1002/phar.1843. View

13.

Welsh T, der Wardt V, Ojo G, Gordon A, Gladman J . Anticholinergic Drug Burden Tools/Scales and Adverse Outcomes in Different Clinical Settings: A Systematic Review of Reviews. Drugs Aging. 2018; 35(6):523-538. DOI: 10.1007/s40266-018-0549-z. View

14.

Tsoi K, Chan J, Hirai H, Wong A, Mok V, Lam L . Recall Tests Are Effective to Detect Mild Cognitive Impairment: A Systematic Review and Meta-analysis of 108 Diagnostic Studies. J Am Med Dir Assoc. 2017; 18(9):807.e17-807.e29. DOI: 10.1016/j.jamda.2017.05.016. View

15.

Chew M, Mulsant B, Pollock B, Lehman M, Greenspan A, Mahmoud R . Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc. 2008; 56(7):1333-41. DOI: 10.1111/j.1532-5415.2008.01737.x. View

16.

Villalba-Moreno A, Alfaro-Lara E, Perez-Guerrero M, Nieto-Martin M, Santos-Ramos B . Systematic review on the use of anticholinergic scales in poly pathological patients. Arch Gerontol Geriatr. 2015; 62:1-8. DOI: 10.1016/j.archger.2015.10.002. View

17.

Pasina L, Lucca U, Tettamanti M . Relation between anticholinergic burden and cognitive impairment: Results from the Monzino 80-plus population-based study. Pharmacoepidemiol Drug Saf. 2020; 29(12):1696-1702. DOI: 10.1002/pds.5159. View

18.

Shah R, Janos A, Kline J, Yu L, Leurgans S, Wilson R . Cognitive decline in older persons initiating anticholinergic medications. PLoS One. 2013; 8(5):e64111. PMC: 3669362. DOI: 10.1371/journal.pone.0064111. View

19.

Salahudeen M, Duffull S, Nishtala P . Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr. 2015; 15:31. PMC: 4377853. DOI: 10.1186/s12877-015-0029-9. View

20.

Tune L . Anticholinergic effects of medication in elderly patients. J Clin Psychiatry. 2001; 62 Suppl 21:11-4. View