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. 2015 Mar 25:15:31.
doi: 10.1186/s12877-015-0029-9.

Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review

Mohammed Saji Salahudeen  1 , Stephen B Duffull  2 , Prasad S Nishtala  3
Affiliations

Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review

Mohammed Saji Salahudeen et al. BMC Geriatr. .

Abstract

Background: The cumulative effect of taking multiple medicines with anticholinergic properties termed as anticholinergic burden can adversely impact cognition, physical function and increase the risk of mortality. Expert opinion derived risk scales are routinely used in research and clinical practice to quantify anticholinergic burden. These scales rank the anticholinergic activity of medicines into four categories, ranging from no anticholinergic activity (= 0) to definite/high anticholinergic activity (= 3). The aim of this systematic review was to compare anticholinergic burden quantified by the anticholinergic risk scales and evaluate associations with adverse outcomes in older people.

Methods: We conducted a literature search in Ovid MEDLINE, EMBASE and PsycINFO from 1984-2014 to identify expert opinion derived anticholinergic risk scales. In addition to this, a citation analysis was performed in Web of Science and Google Scholar to track prospective citing of references of selected articles for assessment of individual scales for adverse anticholinergic outcomes. The primary outcomes of interest were functional and cognitive outcomes associated with anticholinergic burden in older people. The critical appraisals of the included studies were performed by two independent reviewers and the data were extracted onto standardised forms.

Results: The primary electronic literature search identified a total of 1250 records in the 3 different databases. On the basis of full-text analysis, we identified 7 expert-based anticholinergic rating scales that met the inclusion criteria. The rating of anticholinergic activity for medicines among these rating scales was inconsistent. For example, quetiapine was rated as having high anticholinergic activity in one scale (n = 1), moderate in another scale (n = 1) and low in two other scales (n = 2). Citation analysis of the individual scales showed that the Anticholinergic Cognitive Burden (ACB) scale was the most frequently validated expert based anticholinergic scale for adverse outcomes (N = 13).

Conclusions: In conclusion, there is not one standardised tool for measuring anticholinergic burden. Cohort studies have shown that higher anticholinergic burden is associated with negative brain effects, poorer cognitive and functional outcomes.

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Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection process and citation analysis.
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References

    1. Roe CM, Anderson MJ, Spivack B. Use of anticholinergic medications by older adults with dementia. J Am Geriatr Soc. 2002;50(5):836–842. doi: 10.1046/j.1532-5415.2002.50208.x. - DOI - PubMed
    1. Tune LE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry. 2001;62(Suppl 21):11–14. - PubMed
    1. Kersten H, Wyller TB. Anticholinergic drug burden in older people's brain - how well is it measured? Basic Clin Pharmacol Toxicol. 2014;114(2):151–159. doi: 10.1111/bcpt.12140. - DOI - PubMed
    1. Cao YJ, Mager DE, Simonsick EM, Hilmer SN, Ling SM, Windham BG, et al. Physical and cognitive performance and burden of anticholinergics, sedatives, and ACE inhibitors in older women. Clin Pharmacol Therapeut. 2008;83(3):422–429. doi: 10.1038/sj.clpt.6100303. - DOI - PubMed
    1. Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167(8):781–787. doi: 10.1001/archinte.167.8.781. - DOI - PubMed

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