Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022;12(2):599-606.
doi: 10.3233/JPD-212769.

Anticholinergic Medication Burden in Parkinson's Disease Outpatients

Huma Nawaz  1 , Lana Sargent  2   3   4   5 , Helengrace Quilon  6 , Leslie J Cloud  1 , Claudia M Testa  1 , Jon D Snider  1 , Sarah K Lageman  1   7 , Mark S Baron  1   8 , Brian D Berman  1 , Kristin Zimmerman  3 , Elvin T Price  3   4   5 , Nitai D Mukhopadhyay  9 , Matthew J Barrett  1
Affiliations

Anticholinergic Medication Burden in Parkinson's Disease Outpatients

Huma Nawaz et al. J Parkinsons Dis. 2022.

Abstract

Background: Individuals with Parkinson's disease (PD) may be especially vulnerable to future cognitive decline from anticholinergic medications.

Objective: To characterize anticholinergic medication burden, determine the co-occurrence of anticholinergic and cholinesterase inhibitors, and to assess the correlations among anticholinergic burden scales in PD outpatients.

Methods: We studied 670 PD outpatients enrolled in a clinic registry between 2012 and 2020. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Drug Burden Index-Anticholinergic component (DBI-Ach). Correlations between scales were assessed with weighted kappa coefficients.

Results: Between 31.5 to 46.3% of PD patients were taking medications with anticholinergic properties. Among the scales applied, the ACB produced the highest prevalence of medications with anticholinergic properties (46.3%). Considering only medications with definite anticholinergic activity (scores of 2 or 3 on ACB, ADS, or ARS), the most common anticholinergic drug classes were antiparkinsonian (8.2%), antipsychotic (6.4%), and urological (3.3%) medications. Cholinesterase inhibitors and medications with anticholinergic properties were co-prescribed to 5.4% of the total cohort. The most highly correlated scales were ACB and ADS (κ= 0.71), ACB and ARS (κ= 0.67), and ADS and ARS (κ= 0.55).

Conclusion: A high proportion of PD patients (20%) were either taking antiparkinsonian, urological, or antipsychotic anticholinergic medications or were co-prescribed anticholinergic medications and cholinesterase inhibitors. By virtue of its detection of a high prevalence of anticholinergic medication usage and its high correlation with other scales, our data support use of the ACB scale to assess anticholinergic burden in PD patients.

Keywords: Parkinson’s disease; Parkinson’s disease dementia; anticholinergic medications; cholinesterase inhibitors.

PubMed Disclaimer

Conflict of interest statement

CONFLICT OF INTEREST

The authors have no conflict of interest to report.

Figures

Fig. 1.
Fig. 1.
Scatterplots of ACB, ADS, and ARS total scores. These scatterplots display the relationships between the total scores of ACB, ADS, and ARS when categorized as 0, 1, 2, 3, or 4+. Datapoint size represents the number of study participants for each combination of total scores for the comparison of ACB versus ADS (A), ACB versus ARS (B), and ARS versus ADS (C). ACB, Anticholinergic Cognitive Burden scale; ADS, Anticholinergic Drug Scale; ARS, Anticholinergic Risk Scale.
See this image and copyright information in PMC

References

    1. Carrière I, Fourrier-Reglat A, Dartigues J-F, Rouaud O, Pasquier F, Ritchie K, Ancelin M-L (2009) Drugs with anti-cholinergic properties, cognitive decline, and dementia in an elderly general population: The 3-City Study. Arch Intern Med 169, 1317. - PMC - PubMed
    1. Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, Yu O, Crane PK, Larson EB (2015) Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med 175, 401. - PMC - PubMed
    1. Jessen F, Kaduszkiewicz H, Daerr M, Bickel H, Pentzek M, Riedel-Heller S, Wagner M, Weyerer S, Wiese B, van den Bussche H, Broich K, Maier W (2010) Anticholinergic drug use and risk for dementia: target for dementia prevention. Eur Arch Psychiatry Clin Neurosci 260, 111–115. - PubMed
    1. Richardson K, Fox C, Maidment I, Steel N, Loke YK, Arthur A, Myint PK, Grossi CM, Mattishent K, Bennett K, Campbell NL, Boustani M, Robinson L, Brayne C, Matthews FE, Savva GM (2018) Anticholinergic drugs and risk of dementia: case-control study. BMJ 361, k1315. - PMC - PubMed
    1. Campbell NL, Boustani MA, Lane KA, Gao S, Hendrie HM, Khan BA, Murrell JR, Unverzagt FW, Hake A, Smith-Gamble V, Hall K (2010) Use of anticholinergics and the risk of cognitive impairment in an African American population. Neurology 75, 152–159. - PMC - PubMed

Publication types

Substances