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. 2020 Jul 29;20(1):265.
doi: 10.1186/s12877-020-01671-z.

Dose response relationship of cumulative anticholinergic exposure with incident dementia: validation study of Korean anticholinergic burden scale

Yewon Suh  1   2 , Young-Mi Ah  3 , Euna Han  4 , Kwanghee Jun  1 , Sunghee Hwang  5 , Kyung Hee Choi  6 , Ju-Yeun Lee  7
Affiliations

Dose response relationship of cumulative anticholinergic exposure with incident dementia: validation study of Korean anticholinergic burden scale

Yewon Suh et al. BMC Geriatr. .

Abstract

Background: The dose response relationship of nine-year cumulative anticholinergic exposure and dementia onset was investigated using the Korean version anticholinergic burden scale (KABS) in comparison with the Anticholinergic Cognitive Burden Scale (ACB). We also examined the effect of weak anticholinergics in the prediction of dementia.

Methods: A retrospective case-control study was conducted comprising 86,576 patients after 1:2 propensity score matching using the longitudinal national claims database. For cumulative anticholinergic burden estimation, average daily anticholinergic burden score during the 9 years prior to dementia onset was calculated using KABS and ACB and categorized as minimal, < 0.25; low, 0.25-1; intermediate, 1-2; and high, ≥ 2. Adjusted odds ratio (aOR) between cumulative anticholinergic burden and incident dementia was estimated.

Results: Patients with high exposure according to KABS and ACB comprised 3.2 and 3.4% of the dementia cohort and 2.1 and 2.8% of the non-dementia cohort, respectively. Dose-response relationships were observed between anticholinergic burden and incident dementia. After adjusting covariates, compared with minimal exposure, patients with high exposure according to KABS and ACB had a significantly higher risk for incident dementia with aOR of 1.71 (95% confidence interval (CI) 1.55-1.87) and 1.22 (CI 1.12-1.33), respectively. With the exclusion of weak anticholinergics, the association became stronger, i.e., 1.41 (CI 1.14-1.75) with ACB whereas the association became slightly weaker with KABS, i.e., 1.60 (CI 1.38-1.86).

Conclusion: This study confirmed the dose response relationship for cumulative anticholinergic burden measured using the Korean specific anticholinergic burden scale with incident dementia.

Keywords: Aged; Anticholinergic agents; Anticholinergic burden scale; Dementia.

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Conflict of interest statement

All of authors declare that have no competing interests.

Figures

Fig. 1
Fig. 1
The layout of research design. 1) In order to minimize the protopathic bias, the first year before index date was excluded. Also, sensitivity analysis was done after excluding the first 4 years before index date. 2) The Korean version anticholinergic burden scale (KABS) and the Anticholinergic Cognitive Burden Scale (ACB) were used as the standard of anticholinergic burden score. 3) For measuring the sedative load, the sedative load model was used; score 2 for primary sedative agents and score 1 for medications having sedation as a prominent side effects. 4) Matching variables: age, sex, and baseline co-morbid diseases including hypertension, dyslipidemia, heart failure, atrial fibrillation, ischemic heart disease, diabetes mellitus, cerebrovascular disease, Parkinson’s disease, depression, anxiety, insomnia, and alcohol disease
Fig. 2
Fig. 2
Flow chart for selecting patients. NHIS; National Health Insurance Service
See this image and copyright information in PMC

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