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[Preprint]. 2024 Oct 28:rs.3.rs-4682599.
doi: 10.21203/rs.3.rs-4682599/v1.

Deprescribing Anticholinergics to Preserve Brain Health: Reducing the Risk of Dementia through Deprescribing (R2D2): Study Protocol for a Randomized Clinical Trial

Noll L Campbell  1 , Richard J Holden  2 , Sujuan Gao  3 , Frederick W Unverzagt  3 , Kathleen A Lane  3 , Allie Carter  3 , Addison B Harrington  4 , Sneha Manoharan  4 , Neha Manoharan  4 , Danielle L Rosenthal  4 , Christopher Pitts  5 , Kathryn Pelkey  6 , Emily Papineau  6 , David A Lauck  6 , Noha Keshk  7 , Khalid Alamer  8 , Hussein Khalil  7 , Malaz A Boustani  3
Affiliations

Deprescribing Anticholinergics to Preserve Brain Health: Reducing the Risk of Dementia through Deprescribing (R2D2): Study Protocol for a Randomized Clinical Trial

Noll L Campbell et al. Res Sq. .

Update in

Abstract

Background: Older adults commonly experience chronic medical conditions and are at risk of cognitive impairment as a result of age, chronic comorbidity, and medications prescribed to manage multiple chronic conditions. Anticholinergic medications are common treatments for chronic conditions, and have been repeatedly associated with poor cognitive outcomes, including delirium and dementia, in epidemiologic studies. However, no study has definitively evaluated the causal relationship between anticholinergics and cognition in a randomized controlled trial design. Utilizing our prior experience in deprescribing anticholinergic medications in various clinical environments, we designed an outpatient deprescribing intervention to prospectively test the potential causal relationship between anticholinergics and cognition in primary care older adults.

Methods: This cluster randomized clinical trial will be conducted to evaluate the impact of an anticholinergic deprescribing intervention compared to usual care on outcomes of cognition and safety in primary care older adults. Participants will include those aged 65 years and over, receiving primary care in the greater Indianapolis area, using a strong anticholinergic within the last two weeks or with evidence of high-risk exposure in the past year. Those excluded will have a diagnosis of Alzheimer's disease or related dementia, or serious mental illness. The trial plans to enroll 344 participants who will be cluster-randomized at the level of primary care physician to avoid contamination. Participants will complete outcome assessments every six months up to 2 years by blinded outcome assessors. The primary outcome of the study is a composite measure of cognition that includes domains assessing executive cognitive function, language, and memory. Secondary outcomes include patient-reported measures of pain intensity, depression, anxiety, sleep disturbance, and health-related quality of life.

Discussion: The R2D2 trial will be the largest and longest prospective randomized trial testing the impact of an anticholinergic-specific deprescribing intervention on cognition in primary care older adults. Results could influence deprescribing methodology and provide new insight on the relationship between anticholinergics and cognition.

Keywords: Anticholinergics; cognition; dementia; deprescribing.

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Conflict of interest statement

Competing Interests All other authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Conceptual Model of the R2D2 Trial
Figure 2
Figure 2. Overview of the cluster randomized design and outcome assessments
Figure 3
Figure 3. Schedule of enrollment, interventions, and assessments.
*See Table 1 for list of variables and outcomes to be collected at each time point.
Figure 4
Figure 4. Factors to be influenced by the Pharmacist Deprescribing Care Coordinator
See this image and copyright information in PMC

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