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Anticholinergic Cognitive Burden (ACB)

Jonas Reinold, Francesca Palese, Federico Romanese, Giancarlo Logroscino, Oliver Riedel, Federica E Pisa
OBJECTIVES: To evaluate changes in the use of antipsychotics and medications with anticholinergic activity (MACs) during hospitalization in older adults with dementia and factors associated with antipsychotic prescriptions and increased anticholinergic burden (ACB). METHODS AND DESIGN: This retrospective cohort study included all patients aged ≥65 years with a discharge diagnosis of dementia hospitalized at the university hospital of Udine, Italy, 2012-2014. Medications dispensed within 3 months before and after hospitalization, respectively, were identified in community-pharmacy dispensations while those prescribed at discharge were collected from Hospital Electronic Medical Records (EMR)...
February 13, 2019: International Journal of Geriatric Psychiatry
Yash B Joshi, Michael L Thomas, William C Hochberger, Andrew W Bismark, Emily B H Treichler, Juan Molina, John Nungaray, Lauren Cardoso, Joyce Sprock, Neal R Swerdlow, Gregory A Light
Targeted cognitive training (TCT) has been reported to improve verbal learning deficits in patients with schizophrenia (SZ). Despite positive findings, it is not clear whether demographic factors and clinical characteristics contribute to the success of TCT on an individual basis. Medication-associated anticholinergic burden has been shown to impact TCT-associated verbal learning gains in SZ outpatients, but the role of anticholinergic medication burden on TCT gains in treatment refractory SZ patients has not been described...
February 6, 2019: Schizophrenia Research
Ariel R Green, Liza M Reifler, Elizabeth A Bayliss, Linda A Weffald, Cynthia M Boyd
BACKGROUND: It is not known whether drugs with different anticholinergic ratings contribute proportionately to overall anticholinergic score. OBJECTIVES: Our objective was to assess the risk of falls or fall-related injuries as a function of the overall anticholinergic score resulting from drugs with different anticholinergic ratings among people with impaired cognition. METHODS: This was a retrospective cohort study of adults aged  ≥ 65 years with mild cognitive impairment (MCI) or dementia and two or more additional chronic conditions (N = 10,698) in an integrated delivery system...
January 17, 2019: Drugs & Aging
Lana Sargent, Mike Nalls, Elaine J Amella, Martina Mueller, Sarah K Lageman, Stefania Bandinelli, Marco Colpo, Patricia W Slattum, Andrew Singleton, Luigi Ferrucci
Background: The aims of this study were to evaluate the relationship between anticholinergic drug burden (ACB) cognitive impairment, physical frailty and cognitive frailty, and determine if ACB is predictive of these phenotypes when modeled with biological and genomic biomarkers. Methods: In a retrospective cohort study, a total of 1,453 adults aged 20-102 years was used to examine ACB as a predictor for cognitive impairment, physical frailty, and cognitive frailty...
December 26, 2018: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
Young-Mi Ah, Yewon Suh, Kwanghee Jun, Sunghee Hwang, Ju-Yeun Lee
Few studies have evaluated the association between anticholinergic burden and treatment modification after starting a cholinesterase inhibitor in clinical practice. We aimed to evaluate the effect of anticholinergic burden on anti-dementia treatment modification, delirium and mortality. We retrospectively analysed older adults (n = 25,825) who started a cholinesterase inhibitor during 2003-2011 from Korean National Health Insurance Service Senior Cohort Database. High anticholinergic burden was defined as an average daily Anticholinergic Cognitive Burden (ACB) score of >3 during the first three months...
December 3, 2018: Basic & Clinical Pharmacology & Toxicology
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
Luca Pasina, Lorenzo Colzani, Laura Cortesi, Mauro Tettamanti, Antonella Zambon, Alessandro Nobili, Andrea Mazzone, Paolo Mazzola, Giorgio Annoni, Giuseppe Bellelli
BACKGROUND: Delirium is a neuropsychiatric syndrome which occurs on average in one out of five hospitalized older patients. It is associated with a number of negative outcomes, including worsening of cognitive and functional status, increasing the burden on patients and caregivers, and elevated mortality. Medications with anticholinergic effect have been associated with the clinical severity of delirium symptoms in older medical inpatients, but this association is still debated. OBJECTIVE: The aim was to assess the association between delirium and anticholinergic load according to the hypothesis that the cumulative anticholinergic burden increases the risk of delirium...
November 27, 2018: Drugs & Aging
Andrea Corsonello, Annalisa Cozza, Sonia D'Alia, Graziano Onder, Stefano Volpato, Carmelinda Ruggiero, Antonio Cherubini, Mirko Di Rosa, Paolo Fabbietti, Fabrizia Lattanzio
BACKGROUND: The relationship between anticholinergic burden and mortality is controversial, and the impact of anticholinergic burden on prognosis may vary in presence of other conditions common in old age. We aimed at investigating the role of depressive symptoms as potential effect modifiers in the association between anticholinergic burden and 1-year mortality in older patients discharged from hospital. METHODS: Our series consisted of 576 older patients consecutively admitted to seven geriatric and internal medicine acute care wards in the context of a prospective multicenter observational study...
November 15, 2018: European Journal of Internal Medicine
Esther Katharina Kiesel, Yvonne Marina Hopf, Michael Drey
BACKGROUND: Anticholinergic drugs put elderly patients at a higher risk for falls, cognitive decline, and delirium as well as peripheral adverse reactions like dry mouth or constipation. Prescribers are often unaware of the drug-based anticholinergic burden (ACB) of their patients. This study aimed to develop an anticholinergic burden score for drugs licensed in Germany to be used by clinicians at prescribing level. METHODS: A systematic literature search in pubmed assessed previously published ACB tools...
October 11, 2018: BMC Geriatrics
Anne Williams, Leah Sera, Mary Lynn McPherson
BACKGROUND: End-of-life (EOL) patients with dementia have an increased risk for anticholinergic toxicities due to age-related pharmacokinetic and physiologic changes in conjunction with an increased susceptibility to drug-induced cognitive impairments. Despite this well-documented risk, the use of drugs with anticholinergic properties (DAPs) remains prevalent in EOL patients with dementia. OBJECTIVE: The aims of this study were to describe prescribing patterns and characterize anticholinergic burden among hospice patients with dementia, as measured by the Anticholinergic Cognitive Burden (ACB) scale...
September 13, 2018: American Journal of Hospice & Palliative Care
Abdelkrim Ziad, Romain Olekhnovitch, Fabrice Ruiz, Claudine Berr, Bernard Bégaud, Marcel Goldberg, Marie Zins, Thibault Mura
BACKGROUND: Previous studies have shown associations between the use of anticholinergics (AC) and cognitive performance in the elderly, considering AC as a homogeneous set of drugs. The present study aims to assess the relationship between exposure to AC drugs and cognitive performance in middle-aged adults according to AC potency and drug class. METHODS: Our cross-sectional study used baseline data of 34 267 participants aged 45-70 from the Consultants des centres d'examen de santé de la sécurité sociale (CONSTANCES) cohort...
October 2018: Journal of Neurology, Neurosurgery, and Psychiatry
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
Edwin C K Tan, Maria Eriksdotter, Sara Garcia-Ptacek, Johan Fastbom, Kristina Johnell
BACKGROUND: Anticholinergic burden is associated with poorer cognitive and functional outcomes in people with dementia. However, the impact of anticholinergics on significant adverse outcomes such as stroke has not been studied previously. OBJECTIVE: To investigate the association between total anticholinergic cognitive burden (ACB) and risk of stroke and death in people with different dementia subtypes. METHODS: This was a cohort study of 39,107 people with dementia and no prior history of stroke registered in the Swedish Dementia Registry (SveDem) from 2008-2014...
2018: Journal of Alzheimer's Disease: JAD
Fabrizia Lattanzio, Graziano Onder, Mattia Miriam La Fauci, Stefano Volpato, Antonio Cherubini, Paolo Fabbietti, Carmelinda Ruggiero, Sabrina Garasto, Annalisa Cozza, Lucia Crescibene, Assunta Tarsitano, Andrea Corsonello
OBJECTIVES: To determine whether anticholinergic burden may predict differently 1-year mortality in older patients discharged from acute care hospitals with or without dependency in basic activities of daily living (BADL). DESIGN: Prospective observational study. SETTING AND PARTICIPANTS: Our series consisted of 807 patients aged 65 years or older consecutively discharged from 7 acute care geriatric wards throughout Italy between June 2010 and May 2011...
July 23, 2018: Journal of the American Medical Directors Association
I Weichert, R Romero-Ortuno, J Tolonen, T Soe, C Lebus, S Choudhury, C V Nadarajah, P Nanayakkara, M Orrù, S Di Somma
WHAT IS KNOWN AND OBJECTIVE: Drugs with anticholinergic properties increase the risk of falls, delirium, chronic cognitive impairment, and mortality and counteract procholinergic medications used in the treatment of dementia. Medication review and optimisation to reduce anticholinergic burden in patients at risk is recommended by specialist bodies. Little is known how effective this review is in patients who present acutely and how often drugs with anticholinergic properties are used temporarily during an admission...
October 2018: Journal of Clinical Pharmacy and Therapeutics
Kathryn Richardson, Chris Fox, Ian Maidment, Nicholas Steel, Yoon K Loke, Antony Arthur, Phyo K Myint, Carlota M Grossi, Katharina Mattishent, Kathleen Bennett, Noll L Campbell, Malaz Boustani, Louise Robinson, Carol Brayne, Fiona E Matthews, George M Savva
OBJECTIVES: To estimate the association between the duration and level of exposure to different classes of anticholinergic drugs and subsequent incident dementia. DESIGN: Case-control study. SETTING: General practices in the UK contributing to the Clinical Practice Research Datalink. PARTICIPANTS: 40 770 patients aged 65-99 with a diagnosis of dementia between April 2006 and July 2015, and 283 933 controls without dementia...
April 25, 2018: BMJ: British Medical Journal
Avital Hershkovitz, Corina Angel, Shai Brill, Ran Nissan
BACKGROUND: Anticholinergic (AC) drugs are associated with significant impairment in cognitive and physical function which may affect rehabilitation in older people. We aimed to evaluate whether AC burden is associated with rehabilitation achievement in post-acute hip-fractured patients. METHODS: A retrospective cohort study carried out in a post-acute geriatric rehabilitation center on 1019 hip-fractured patients admitted from January 2011 to October 2015. The Anticholinergic Cognitive Burden Scale (ACB) was used to quantify the AC burden...
April 2018: Drugs & Aging
Ariel R Green, Liza M Reifler, Cynthia M Boyd, Linda A Weffald, Elizabeth A Bayliss
BACKGROUND: Drugs with anticholinergic properties are considered potentially inappropriate in patients with cognitive impairment because harms-including delirium, falls, and fractures-may outweigh benefits. OBJECTIVE: To highlight opportunities to improve clinical decision making and care for patients with cognitive impairment and multiple chronic conditions, we identified distinct subgroups of patients with mild cognitive impairment (MCI) and dementia who had high cumulative anticholinergic burden and specific patterns of anticholinergic use...
March 2018: Drugs & Aging
Fabrizia Lattanzio, Francesco Corica, Roberto Schepisi, Diana Amantea, Francesco Bruno, Annalisa Cozza, Graziano Onder, Stefano Volpato, Antonio Cherubini, Carmelinda Ruggiero, Marcello G Maggio, Andrea Corsonello
AIM: The association between anticholinergic burden and mortality is controversial. We aimed to investigate whether the anticholinergic cognitive burden (ACB) score predicts 1-year mortality in older patients discharged from acute care hospitals. METHODS: Our series consisted of 807 hospitalized patients aged ≥65 years. Patients were followed up for 12 months after discharge. All-cause mortality was the outcome of the study. The ACB score at discharge (0, 1, ≥2) and increasing ACB score from admission to discharge (no increase, +1, +2 or more) were calculated and used as exposure variables...
May 2018: Geriatrics & Gerontology International
Christopher Tsoutsoulas, Benoit H Mulsant, Sanjeev Kumar, Zaid Ghazala, Aristotle N Voineskos, Mahesh Menon, Bruce G Pollock, Tarek K Rajji
OBJECTIVE: Older individuals with schizophrenia are at risk of being treated with anticholinergic medications due to the prevalence of medical comorbidities and polypharmacy. High anticholinergic burden impairs cognition and is a risk factor for Alzheimer's dementia. Thus, we assessed the impact of anticholinergic burden on Alzheimer's dementia-related and schizophrenia-related cognitive functions in older patients with schizophrenia. METHODS: Anticholinergic burden was measured using the Anticholinergic Cognitive Burden scale (ACB) in 60 community-dwelling patients aged ≥ 50 years who met DSM-IV criteria for schizophrenia between May 2007 and November 2011...
November 2017: Journal of Clinical Psychiatry
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