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Anticholinergic burden and cognitive function in a large German cohort of hospitalized geriatric patients.
PLoS One. 2017; 12(2):e0171353.Plos

Abstract

PURPOSE

Previous studies suggest an association between use of anticholinergic drugs in elderly patients and cognitive impairment. However, there are still limited data on the association of anticholinergic drug use and cognitive impairment as well as contribution of individual drugs to anticholinergic load using large, well-documented patient cohorts treated in geriatric units from Europe.

METHODS

We investigated 797,440 prescriptions to 89,579 hospitalized patients treated in geriatric units within the GiB-DAT database. Data of all patients discharged between 1 January 2013 and 30 June 2015 was included. The Anticholinergic Cognitive Burden (ACB) scale was used to classify anticholinergic drugs as definite (score 2 or 3) and possible anticholinergics (score 1). Cognitive function was determined using Mini-Mental State Examination (MMSE) and the standardized scale for dementia (4D+S).

RESULTS

In two multivariable logistic regression models age, sex, number of drugs and ACB total scores were identified as variables independently associated with cognitive impairment as measured by MMSE (odds ratio per ACB unit 1.114, 95% CI 1.099-1.130) or the diagnosis dementia (odds ratio 1.159 per ACB unit, 95% CI 1.144-1.173, both p < 0.0001). High anticholinergic load was associated with patients with severe cognitive impairment (p < 0.05 for all pairwise comparisons). ACB score 3 anticholinergic drugs contributed 77.9% to the cumulative amount of ACB points in patients with an anticholinergic load of 3 and higher.

CONCLUSIONS

Using a cross-sectional study design, a significant positive association between anticholinergic drug load and cognitive impairment in European patients treated in specialised geriatric units was found. The most frequently used definitve anticholinergic drugs were quetiapine, amitriptyline and carbamazepine.

Authors+Show Affiliations

Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of Experimental and Clinical Pharmacology and Toxicology, Fahrstraβe 17, Erlangen, Germany.GiB-DAT Database, Nürnberg, Germany.GiB-DAT Database, Nürnberg, Germany. Waldkrankenhaus St. Marien gGmbH, Internal Medicine III, Geriatrics Center Erlangen, Erlangen, Germany.Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of Experimental and Clinical Pharmacology and Toxicology, Fahrstraβe 17, Erlangen, Germany.Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute of Experimental and Clinical Pharmacology and Toxicology, Fahrstraβe 17, Erlangen, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28187171

Citation

Pfistermeister, Barbara, et al. "Anticholinergic Burden and Cognitive Function in a Large German Cohort of Hospitalized Geriatric Patients." PloS One, vol. 12, no. 2, 2017, pp. e0171353.
Pfistermeister B, Tümena T, Gaβmann KG, et al. Anticholinergic burden and cognitive function in a large German cohort of hospitalized geriatric patients. PLoS One. 2017;12(2):e0171353.
Pfistermeister, B., Tümena, T., Gaβmann, K. G., Maas, R., & Fromm, M. F. (2017). Anticholinergic burden and cognitive function in a large German cohort of hospitalized geriatric patients. PloS One, 12(2), e0171353. https://doi.org/10.1371/journal.pone.0171353
Pfistermeister B, et al. Anticholinergic Burden and Cognitive Function in a Large German Cohort of Hospitalized Geriatric Patients. PLoS One. 2017;12(2):e0171353. PubMed PMID: 28187171.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anticholinergic burden and cognitive function in a large German cohort of hospitalized geriatric patients. AU - Pfistermeister,Barbara, AU - Tümena,Thomas, AU - Gaβmann,Karl-Günter, AU - Maas,Renke, AU - Fromm,Martin F, Y1 - 2017/02/10/ PY - 2016/08/21/received PY - 2017/01/18/accepted PY - 2017/2/11/entrez PY - 2017/2/12/pubmed PY - 2017/8/10/medline SP - e0171353 EP - e0171353 JF - PloS one JO - PLoS One VL - 12 IS - 2 N2 - PURPOSE: Previous studies suggest an association between use of anticholinergic drugs in elderly patients and cognitive impairment. However, there are still limited data on the association of anticholinergic drug use and cognitive impairment as well as contribution of individual drugs to anticholinergic load using large, well-documented patient cohorts treated in geriatric units from Europe. METHODS: We investigated 797,440 prescriptions to 89,579 hospitalized patients treated in geriatric units within the GiB-DAT database. Data of all patients discharged between 1 January 2013 and 30 June 2015 was included. The Anticholinergic Cognitive Burden (ACB) scale was used to classify anticholinergic drugs as definite (score 2 or 3) and possible anticholinergics (score 1). Cognitive function was determined using Mini-Mental State Examination (MMSE) and the standardized scale for dementia (4D+S). RESULTS: In two multivariable logistic regression models age, sex, number of drugs and ACB total scores were identified as variables independently associated with cognitive impairment as measured by MMSE (odds ratio per ACB unit 1.114, 95% CI 1.099-1.130) or the diagnosis dementia (odds ratio 1.159 per ACB unit, 95% CI 1.144-1.173, both p < 0.0001). High anticholinergic load was associated with patients with severe cognitive impairment (p < 0.05 for all pairwise comparisons). ACB score 3 anticholinergic drugs contributed 77.9% to the cumulative amount of ACB points in patients with an anticholinergic load of 3 and higher. CONCLUSIONS: Using a cross-sectional study design, a significant positive association between anticholinergic drug load and cognitive impairment in European patients treated in specialised geriatric units was found. The most frequently used definitve anticholinergic drugs were quetiapine, amitriptyline and carbamazepine. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/28187171/Anticholinergic_burden_and_cognitive_function_in_a_large_German_cohort_of_hospitalized_geriatric_patients_ L2 - https://dx.plos.org/10.1371/journal.pone.0171353 DB - PRIME DP - Unbound Medicine ER -