Is there an anticholinergic effect of drugs beyond polypharmacy? A simulation study on death, dementia, and delirium in UK Biobank

medRxiv (Cold Spring Harbor Laboratory), Год журнала: 2024, Номер unknown

Опубликована: Авг. 6, 2024

The use of anticholinergic drugs has been associated with adverse health outcomes. However, their effects cannot be completely separated from the general polypharmacy using standard methods. objective this study was to explore extent which detrimental attributed burden measured by scales (ABS) were distinct those polypharmacy. We compared observed ABS against simulated generated pseudoscales intended measure UK Biobank primary care data. randomly sampled 525 and non-anticholinergic prescribed in year 2015 ~200,000 participants an average age 65 years. then created 1,000 pseudoscales, score designed represent strength background effect polypharmacy, differentiating constructed capture either or putative exhibiting similar distributional properties 23 real-world (statistical equivalence). performed individual logistic regressions for each scale estimate associations between respectively, risk death, dementia, delirium. Across outcomes, odds ratios anticholinergic-polypharmacy on 0.03-0.05 greater than general-polypharmacy pseudoscales. number composing correlated size both (r=~0.5, p<0.001) (r=~0.7, p<0.001). In total, 50-90% showed stronger majority exhibited studied outcomes would expected alone (range differences ratios: -0.05 0.20). Most existing more variance association delirium alone, but varying degrees strength.

Язык: Английский

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Impact of the Anticholinergic Burden on Disease-Specific Symptoms in Parkinsonian Syndromes

Brain Sciences, Год журнала: 2024, Номер 14(8), С. 805 - 805

Опубликована: Авг. 11, 2024

Background: Anticholinergic adverse effects pose a relevant threat to patients, in particular elderly and cognitively impaired patients. Patients with Parkinsonian syndromes are especially at risk from anticholinergic due the often-required complex drug therapy. Aims: The aim of this study was evaluate potential effect burden on motor non-motor symptoms Parkinson’s disease atypical syndromes. Methods: This cross-sectional, monocentric retrospective data analysis included 151 patients (PD), 63 progressive supranuclear palsy (PSP), 36 multiple system atrophy (MSA). patients’ medications determined using two established scores: Drug Scale (ADS) German Burden (GABS). These scores were compared between different diseases correlated several disease-specific scores. Results: higher PD, particular, PSP. In PD group, showed weak correlation almost all analyzed clinical number administered drugs. UMSARS I II significant MSA general, GABS-measured significantly ADS-measured. Conclusions: calculated affected various poorly. Since GABS also contains basic anti-parkinsonian drugs, score tended overestimate and, therefore, seemed less appropriate for application.

Язык: Английский

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Increased anticholinergic medication use in middle aged and older autistic adults and its associations with self-reported memory difficulties and cognitive decline

Опубликована: Июнь 16, 2023

Many commonly used prescription and over-the-counter medicines have potent anticholinergic (AC) effects. Among older adults, AC medications are associated with cognitive impairment, risk for disorders, including Alzheimer’s Disease. Collectively, the impact of is known as burden (ACB). Because high rates co-occurring medical psychiatric conditions, autistic adults may exposure, thus, experience elevated ACB. However, no research has characterized exposure or examined its associations outcomes in adults. Autistic (40-83 years) recruited via Simons Powering Autism Research’s (SPARK) Research Match service self-reported their medication use (N=415) memory complaints (N=382) at Time (T)1. At T2, two years later, a subset T1 participants (N=197) on decline cognition. Medications were coded using scales potency. A proportion (48.2% to 62.9%, depending upon potency scale) reported taking least one effects, 20.5% 26.5% clinically-relevant levels (potency ≥3). After controlling birth-sex age, hierarchical linear regression models showed total ACB scores values ≥3 predicted greater complaints. Logistic that follow-up later. Understanding medications—including potentially earlier polypharmacy—and impacts cognition (e.g., dementia risk) warranted.

Язык: Английский

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Anticholinergic burden risk and prevalence of medications carrying anticholinergic properties in elderly cancer patients in Jordan

Saudi Pharmaceutical Journal, Год журнала: 2023, Номер 31(9), С. 101710 - 101710

Опубликована: Июль 27, 2023

Geriatric cancer patients are susceptible to adverse drug events due the complexity of their chemotherapy regimens and collateral treatments for comorbid conditions. Prescribing medications with anticholinergic burden characteristics can complicate condition, leading negative impacts on health outcomes quality life, including an increase in event frequency, physical cognitive impairments.This study aims examine prevalence prescribing identify cumulative load risk associated drugs prescribed elderly patients. Also, predictors that might lead raised these patients.This retrospective cross-sectional included (age ≥ 65) diagnosed admitted adult oncology unit at King Abdullah University Hospital (KAUH) Jordan during period between (January 1st, 2019, January 2022). The medication charts 420 were evaluated outcomes.Of total subjects, females represented 49.3%, average age was 72.95 (SD = 7.33). A 354 (84.3%) least one carrying properties. Median 3 (IQR 4). Our found 194 (46.2%) a high (cumulative score 3). Metoclopramide, furosemide, tramadol most frequently Alimentary tract action commonly encountered items our population.Our revealed significantly among Nearly half developing serious effects related activity from administered. Polypharmacy strongly increased score. Evidence-based recommendations utilizing strategies safer alternatives deprescribing inappropriate could reduce such prescribing.

Язык: Английский

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Polypharmacy and associated cumulative anticholinergic burden are important predictors of falls risk

British Journal of Clinical Pharmacology, Год журнала: 2023, Номер 89(7), С. 2332 - 2333

Опубликована: Май 3, 2023

It is evident that polypharmacy among older adults results in increased cumulative anticholinergic exposure and several adverse outcomes. We read with interest congratulate Hilmer et al. on their multicentre cohort study Australia, investigating the association between sedative medication The authors conclude potentially inappropriate medications (PIMS) drug burden index (DBI) are significantly associated risks of fall delirium.1 would like to share our experience from United Kingdom where a known growing phenomenon effects adults.2 investigated potential confounding (ACB) hospitalized fall. prospectively evaluated 411 consecutive patients aged ≥65 years (mean age 83.8 ± 8.0 years: 40.6% male) admitted acutely hospital. Pharmacological reconciliation was carried out by hospital pharmacists utilizing national patient database: NHS Summary Care Record, which contains all regular acute prescriptions. Incidence (defined as prescription ≥5 oral medications), ACB score (http://www.acbcalc.com/) Charlson Comorbidity Index (CCI) were recorded compared or without further polypharmacy, summative score, CCI, falls risk. Overall incidence group 80.8%, consistent previous epidemiology studies.3 Polypharmacy 76.3% 88.0%, respectively. 0, 1, 2 ≥3 38.7%, 20.9%, 14.6% 25.8%, On multivariate analysis, (OR = 1.030, [1.000; 1.050], P 0.049), 1.150, [1.020; 1.290], 0.025), 2.140, [1.190; 3.870], 0.012) but not CCI 0.920, [0.810; 1.040], 0.172) higher rate (Table 1). linear regression an 3 0 have >50% chance falling. also found fall, 29.8% had drug-related orthostatic hypotension, 24.7% bradycardia, 37.3% prescribed centrally acting drugs 12.0% taking hypoglycaemic agents. Our complements findings other recent studies suggesting risk adults.2, 4, 5 data demonstrated presence each unit rise stronger effect increasing comorbidities. modifiable factors, strongly support deprescribing when possible prevent improve outcomes adults.6, 7 Further required clinical benefits its feasibility setting. None.

Язык: Английский

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