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Anticholinergic Risk Scale (ARS)

Yacine Jaïdi, Adrien Guilloteau, Vignon Nonnonhou, Laurie-Anne Bertholon, Sarah Badr, Isabella Morrone, Jean-Luc Novella, Rachid Mahmoudi
BACKGROUND: A high anticholinergic burden (AB) is associated with the occurrence of behavioral and psychological symptoms (BPSDs), which are frequent in dementia. OBJECTIVES: Our aim was to determine the threshold for a reduction in AB that would lead to a clinically significant improvement in BPSDs (in terms of frequency, severity, and disruptiveness). DESIGN: A single-center prospective study. SETTINGS: Dedicated geriatric care unit specializing in the management of patients with dementia...
November 28, 2018: Journal of the American Medical Directors Association
Gloria Brombo, Lara Bianchi, Elisa Maietti, Francesca Malacarne, Andrea Corsonello, Antonio Cherubini, Carmelinda Ruggiero, Graziano Onder, Stefano Volpato
BACKGROUND: Medications with anticholinergic properties, although widely used, may negatively affect cognitive and functional status in older patients. To date there is still no standardized method to quantify anticholinergic exposure. We analyzed the relationship of two different tools for the evaluation of the anticholinergic drug burden with cognitive and functional impairment in a sample of older hospitalized patients. METHODS: A retrospective and longitudinal analysis with 1-year follow-up of 1123 older hospitalized patients enrolled in seven Italian acute care wards was conducted...
October 2018: Drugs & Aging
E Kose, T Hirai, T Seki, S Hidaka, T Hamamoto
WHAT IS KNOWN AND OBJECTIVE: Anticholinergic drugs are associated with risks of falls, confusion and cognitive dysfunction. However, the effect of anticholinergic drug use on rehabilitation outcomes after a stroke is poorly documented. We therefore aimed to establish whether the anticholinergic load was associated with functional recovery among geriatric patients convalescing after stroke. METHOD: Consecutive geriatric stroke patients admitted and discharged from a convalescence rehabilitation ward between 2010 and 2016 were included in this retrospective cohort study...
December 2018: Journal of Clinical Pharmacy and Therapeutics
Daniel I McIsaac, Coralie A Wong, Deric Diep, Carl van Walraven
OBJECTIVE: The aim of this study was to measure the association of preoperative anticholinergic exposure with length of stay (LOS) and other outcomes in older people having elective noncardiac surgery. SUMMARY BACKGROUND DATA: Anticholinergic medications are associated with adverse events in nonsurgical populations; the association of anticholinergic medications with outcomes in elective surgery patients is poorly described. METHODS: We conducted a retrospective, population-based cohort study using linked administrative data in Ontario, Canada...
April 18, 2018: Annals of Surgery
Manuel E Machado-Duque, Juan Pablo Castaño-Montoya, Diego A Medina-Morales, Alejandro Castro-Rodríguez, Alexandra González-Montoya, Jorge E Machado-Alba
BACKGROUND/OBJECTIVE: To determine the association between the use of anticholinergic drugs and the risk of falls with hip fracture in a population older than 60 years. METHODS: A case-control study in patients older than 60 years with a diagnosis of hip fracture. All drugs dispensed during the previous 30 days were identified. Sociodemographic, clinical, pharmacological (drugs according to the Anticholinergic Risk Scale [ARS]), and polypharmacy variables were analyzed...
March 2018: Journal of Geriatric Psychiatry and Neurology
Alejandro Ballesteros, Ana M Sánchez-Torres, Jose M López-Ilundain, Bibiana Cabrera, Antonio Lobo, Ana M González-Pinto, Covadonga Díaz-Caneja, Iluminada Corripio, Eduard Vieta, Elena de la Serna, Julio Bobes, Judith Usall, Fernando Contreras, Ruth Lorente-Omeñaca, Gisela Mezquida, Miguel Bernardo, Manuel J Cuesta
BACKGROUND: Cognitive deficits are a core feature of early stages in schizophrenia. However, the extent to which antipsychotic (AP) have a deleterious effect on cognitive performance remains under debate. We aim to investigate whether anticholinergic loadings and dose of AP drugs in first episode of psychosis (FEP) in advanced phase of remission are associated with cognitive impairment and the differences between premorbid intellectual quotient (IQ) subgroups. METHODS: Two hundred and sixty-six patients participated...
October 2018: Psychological Medicine
Andrea Casajús-Navasal, Raquel Marín-Gorricho, Jara Gallardo-Anciano, María José Nebot-Villacampa, Ricardo Zafra-Morales, Yared González-Pérez
OBJECTIVE: To analyse anticholinergic agent consumption in HIV patients 50  years or older; to determine anticholinergic risk using the ACB and ARS scales;  and to determine if these patients use any type of benzodiazepine. METHOD: A descriptive observational study of 256 HIV patients 50 years or  older. RESULTS: 73.1% were men. Mean age was 56 ± 5.9 years. 55.9% of the  patients were coinfected with HCV. Excluding HIV drugs, mean drug consumption was 2...
January 1, 2018: Farmacia Hospitalaria
Wen-Han Hsu, Yu-Wen Wen, Liang-Kung Chen, Fei-Yuan Hsiao
PURPOSE: No consensus has been reached regarding which anticholinergic scoring system works most effectively in clinical settings. The aim of this population-based cohort study was to examine the association between anticholinergic medication burden, as defined by different scales, and adverse clinical outcomes among older adults. METHODS: From Taiwan's Longitudinal Health Insurance Database, we retrieved data on monthly anticholinergic drug use measured by the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden Scale (ACB), and the Drug Burden Index - Anticholinergic component (DBI-Ach) for 116,043 people aged 65 years and older during a 10-year follow-up...
November 2017: Annals of Family Medicine
Marta Gutiérrez-Valencia, Nicolás Martínez-Velilla, Davide Liborio Vetrano, Andrea Corsonello, Fabrizia Lattanzio, Sergio Ladrón-Arana, Graziano Onder
PURPOSE: The purpose of this study is to investigate whether there is an association between anticholinergic burden and mortality or rehospitalization in older adults discharged from hospital. METHODS: Prospective multicenter cohort study carried out with patients aged 65 and older discharged from seven acute care hospitals. The primary outcomes of the study were rehospitalization and mortality within 1 year after discharge. The study population was classified in three groups according to the anticholinergic exposure measured by the Anticholinergic Risk Scale (ARS) and Durán's list at the time of hospital discharge: without risk (ARS/Durán = 0), low risk (ARS/Durán = 1), and high risk (ARS/Durán ≥ 2)...
November 2017: European Journal of Clinical Pharmacology
Virginie Dauphinot, Christelle Mouchoux, Sébastien Veillard, Floriane Delphin-Combe, Pierre Krolak-Salmon
BACKGROUND: Drugs with anticholinergic properties may be associated with various adverse clinical effects. The relationship between the anticholinergic (AC) burden and functional, global cognitive performance and behavior disturbances was assessed among elderly patients. METHODS: A cross-sectional study was conducted between January 2012 and June 2014 in a memory clinic among outpatients living at home and with subjective cognitive decline (SCD) or neurocognitive disorders (NCD)...
August 1, 2017: Alzheimer's Research & Therapy
Angelique Egberts, Saskia T van der Craats, Melissa D van Wijk, Shams Alkilabe, Patricia M L A van den Bemt, Francesco U S Mattace-Raso
Several studies investigated the possible association between anticholinergic drugs and diverse clinical outcomes in older persons, but the results are inconsistent. The aim of this study was to investigate whether anticholinergic drug exposure is associated with delirium on admission, length of hospital stay, postdischarge institutionalization and in-hospital mortality in acutely ill hospitalized older patients. In this observational chart review study, we included acutely ill patients aged 65 and older who were admitted to the geriatric ward of the Erasmus University Medical Center, Rotterdam, The Netherlands, between 2012 and 2015 ( n  = 905)...
June 2017: Pharmacology Research & Perspectives
Aurora M Rojo-Sanchís, Manuel Vélez-Díaz-Pallarés, María Muñoz García, Eva Delgado Silveira, Teresa Bermejo Vicedo, Alfonso Cruz Jentoft
BACKGROUND: The use of anticholinergic drugs in the elderly has been associated to an increased frequency of delirium. There are different scales for estimating the anticholinergic burden, such as the Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Anticholinergic Cognitive Burden (ACB). The aim of the study is to establish the relationship between anticholinergic burden measured by ADS, ARS, and ACB scales and incident or prevalent delirium. METHODS: An ambispective observational study was conducted for 76 days in the acute geriatric unit of a tertiary hospital...
July 2016: Revista Española de Geriatría y Gerontología
Arduino A Mangoni, Susan Kim, Paul Hakendorf, Lidia Mayner, Richard J Woodman
OBJECTIVES: To determine whether heat waves (HWs) affect exposure to drugs with anticholinergic effects (DACEs) on admission and the effect of such on length of stay (LOS) and in-hospital mortality in older adults. DESIGN: Retrospective. SETTING: Metropolitan teaching hospital. PARTICIPANTS: Individuals aged 65 and older with at least one chronic condition (n = 307) admitted to a medical ward during five consecutive HWs (≥5 consecutive days of a maximum temperature of ≥35 °C or ≥3 consecutive days of a maximum temperature of ≥40 °C) recorded between 2007 and 2009...
May 2016: Journal of the American Geriatrics Society
Rebecca J Hanus, Kristina S Lisowe, Jens C Eickhoff, Mara A Kieser, Jamie L Statz-Paynter, Joseph A Zorek
OBJECTIVES: To determine primary care physician (PCP) acceptance rates of electronic medication therapy recommendations based on anticholinergic burden for high-risk elderly patients, and to evaluate potential associations between recommendation acceptance and patient-provider characteristics. SETTING: Two medical clinics within Dean Health System, an integrated health care organization comprising ambulatory surgery centers, medical clinics, community pharmacies, specialty pharmacies, a health plan, and a pharmacy benefits management company...
September 2016: Journal of the American Pharmacists Association: JAPhA
James A G Crispo, Allison W Willis, Dylan P Thibault, Yannick Fortin, Harlen D Hays, Douglas S McNair, Lise M Bjerre, Dafna E Kohen, Santiago Perez-Lloret, Donald R Mattison, Daniel Krewski
BACKGROUND: Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on anticholinergic burden are limited in subpopulations, such as individuals with Parkinson disease (PD). The objective of this study was to determine whether anticholinergic burden was associated with adverse outcomes in a PD inpatient population. METHODS: Using the Cerner Health Facts® database, we retrospectively examined anticholinergic medication use, diagnoses, and hospital revisits within a cohort of 16,302 PD inpatients admitted to a Cerner hospital between 2000 and 2011...
2016: PloS One
Angela Maria Villalba-Moreno, Eva Rocío Alfaro-Lara, Maria Concepción Pérez-Guerrero, Maria Dolores Nieto-Martín, Bernardo Santos-Ramos
PURPOSE: Anticholinergic drugs may increase the risk of cognitive and functional disorders in older patients. There are anticholinergic scales on which said risk is estimated. The objectives of this study are: to identify the scales described in literature that are applicable to polypathological patients and analyze their clinical outcomes. MATERIAL AND METHODS: A systematic review was performed. Data sources were MEDLINE, EMBASE and Web of Science which were consulted until August 2014...
January 2016: Archives of Gerontology and Geriatrics
Jennifer G Naples, Zachary A Marcum, Subashan Perera, Shelly L Gray, Anne B Newman, Eleanor M Simonsick, Kristine Yaffe, Ronald I Shorr, Joseph T Hanlon
OBJECTIVES: To evaluate concordance of five commonly used anticholinergic scales. DESIGN: Cross-sectional secondary analysis. SETTING: Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS: Community-dwelling adults aged 70 to 79 with baseline medication data from the Health, Aging, and Body Composition Study (N = 3,055). MEASUREMENTS: Any anticholinergic use, weighted scores, and total standardized daily dosage were calculated using five anticholinergic measures (Anticholinergic Cognitive Burden (ACB) Scale, Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), Drug Burden Index anticholinergic component (DBI-ACh), and Summated Anticholinergic Medications Scale (SAMS))...
October 2015: Journal of the American Geriatrics Society
Lisa G Pont, Johannes T H Nielen, Andrew J McLachlan, Danijela Gnjidic, Lewis Chan, Robert G Cumming, Katja Taxis
AIMS: Anticholinergic drug exposure is associated with adverse outcomes in older people. While a number of tools have been developed to measure anticholinergic drug exposure, there is limited information about the agreement and overlap between the various scales. The aim of this study was to investigate the agreement and overlap between different measures of anticholinergic drug exposure in a cohort of community-dwelling older men. METHODS: A cross-sectional study was used to compare anticholinergic drug exposure calculated using the Anticholinergic Risk Scale (ARS), the Anticholinergic Drug Scale (ADS), the Anticholinergic Cognitive Burden (ACB) and the Drug Burden Index anticholinergic subscale (DBI-ACH) in a cohort of community-dwelling men aged 70 years and older (n = 1696)...
November 2015: British Journal of Clinical Pharmacology
Kimberley Ruxton, Richard J Woodman, Arduino A Mangoni
AIM: The aim was to investigate associations between drugs with anticholinergic effects (DACEs) and cognitive impairment, falls and all-cause mortality in older adults. METHODS: A literature search using CINAHL, Cochrane Library, Embase and PubMed databases was conducted for randomized controlled trials, prospective and retrospective cohort and case-control studies examining the use of DACEs in subjects ≥65 years with outcomes on falls, cognitive impairment and all-cause mortality...
August 2015: British Journal of Clinical Pharmacology
Jacquia F De La Cruz, Cassandra Kisby, Jennifer M Wu, Elizabeth J Geller
INTRODUCTION AND HYPOTHESIS: Our aim was to evaluate the impact of anticholinergic load on urinary retention based on postvoid residual (PVR) on micturition study. Secondary objectives were to assess the effect of anticholinergic load on other urodynamic parameters. METHODS: This was a retrospective cohort study of women who underwent urodynamics (UDS) at one academic institution. All medications being taken by the women at the time of UDS were scored using the anticholinergic risk scale (ARS)...
April 2015: International Urogynecology Journal
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