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Concordance Between Anticholinergic Burden Scales.
J Am Geriatr Soc. 2015 Oct; 63(10):2120-4.JA

Abstract

OBJECTIVES

To evaluate concordance of five commonly used anticholinergic scales.

DESIGN

Cross-sectional secondary analysis.

SETTING

Pittsburgh, Pennsylvania, and Memphis, Tennessee.

PARTICIPANTS

Community-dwelling adults aged 70 to 79 with baseline medication data from the Health, Aging, and Body Composition Study (N = 3,055).

MEASUREMENTS

Any anticholinergic use, weighted scores, and total standardized daily dosage were calculated using five anticholinergic measures (Anticholinergic Cognitive Burden (ACB) Scale, Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), Drug Burden Index anticholinergic component (DBI-ACh), and Summated Anticholinergic Medications Scale (SAMS)). Concordance was evaluated using kappa statistics and Spearman rank correlations.

RESULTS

Any anticholinergic use in rank order was 51% for the ACB, 43% for the ADS, 29% for the DBI-ACh, 23% for the ARS, and 16% for the SAMS. Kappa statistics for all pairwise use comparisons ranged from 0.33 to 0.68. Similarly, concordance as measured using weighted kappa statistics ranged from 0.54 to 0.70 for the three scales not incorporating dosage (ADS, ARS, ACB). Spearman rank correlation between the DBI-ACh and SAMS was 0.50.

CONCLUSION

Only low to moderate concordance was found between the five anticholinergic scales. Future research is needed to examine how these differences in measurement affect their predictive validity with respect to clinically relevant outcomes, such as cognitive impairment.

Authors+Show Affiliations

Division of Geriatrics, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania. Center for Health Equity Research and Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.School of Pharmacy, University of Washington, Seattle, Washington.Division of Geriatrics, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.School of Pharmacy, University of Washington, Seattle, Washington.Division of Geriatrics, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.Intramural Research Program, National Institute on Aging, Baltimore, Maryland.Department of Psychiatry, University of California at San Francisco, San Francisco, California. Department of Neurology, University of California at San Francisco, San Francisco, California. Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California. San Francisco Veterans Affairs Medical Center, San Francisco, California.Geriatric Research, Education and Clinical Center, Malcolm Randall Veterans Affairs Medical Center, Gainesville, Florida.Division of Geriatrics, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania. Center for Health Equity Research and Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural

Language

eng

PubMed ID

26480974

Citation

Naples, Jennifer G., et al. "Concordance Between Anticholinergic Burden Scales." Journal of the American Geriatrics Society, vol. 63, no. 10, 2015, pp. 2120-4.
Naples JG, Marcum ZA, Perera S, et al. Concordance Between Anticholinergic Burden Scales. J Am Geriatr Soc. 2015;63(10):2120-4.
Naples, J. G., Marcum, Z. A., Perera, S., Gray, S. L., Newman, A. B., Simonsick, E. M., Yaffe, K., Shorr, R. I., & Hanlon, J. T. (2015). Concordance Between Anticholinergic Burden Scales. Journal of the American Geriatrics Society, 63(10), 2120-4. https://doi.org/10.1111/jgs.13647
Naples JG, et al. Concordance Between Anticholinergic Burden Scales. J Am Geriatr Soc. 2015;63(10):2120-4. PubMed PMID: 26480974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Concordance Between Anticholinergic Burden Scales. AU - Naples,Jennifer G, AU - Marcum,Zachary A, AU - Perera,Subashan, AU - Gray,Shelly L, AU - Newman,Anne B, AU - Simonsick,Eleanor M, AU - Yaffe,Kristine, AU - Shorr,Ronald I, AU - Hanlon,Joseph T, AU - ,, PY - 2015/10/21/entrez PY - 2015/10/21/pubmed PY - 2016/1/26/medline KW - aged KW - cholinergic antagonists KW - drug use SP - 2120 EP - 4 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 63 IS - 10 N2 - OBJECTIVES: To evaluate concordance of five commonly used anticholinergic scales. DESIGN: Cross-sectional secondary analysis. SETTING: Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS: Community-dwelling adults aged 70 to 79 with baseline medication data from the Health, Aging, and Body Composition Study (N = 3,055). MEASUREMENTS: Any anticholinergic use, weighted scores, and total standardized daily dosage were calculated using five anticholinergic measures (Anticholinergic Cognitive Burden (ACB) Scale, Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), Drug Burden Index anticholinergic component (DBI-ACh), and Summated Anticholinergic Medications Scale (SAMS)). Concordance was evaluated using kappa statistics and Spearman rank correlations. RESULTS: Any anticholinergic use in rank order was 51% for the ACB, 43% for the ADS, 29% for the DBI-ACh, 23% for the ARS, and 16% for the SAMS. Kappa statistics for all pairwise use comparisons ranged from 0.33 to 0.68. Similarly, concordance as measured using weighted kappa statistics ranged from 0.54 to 0.70 for the three scales not incorporating dosage (ADS, ARS, ACB). Spearman rank correlation between the DBI-ACh and SAMS was 0.50. CONCLUSION: Only low to moderate concordance was found between the five anticholinergic scales. Future research is needed to examine how these differences in measurement affect their predictive validity with respect to clinically relevant outcomes, such as cognitive impairment. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/26480974/Concordance_Between_Anticholinergic_Burden_Scales_ L2 - https://doi.org/10.1111/jgs.13647 DB - PRIME DP - Unbound Medicine ER -