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Anticholinergic Burden and Functional Status in Older People with Cognitive Impairment: Results from the Regal Project.
J Nutr Health Aging. 2017; 21(4):389-396.JN

Abstract

OBJECTIVE

The use of drugs with intrinsic anticholinergic properties is widespread among old age persons. A growing body of evidences suggest that a high anticholinergic burden is associated with physical and cognitive impairment. However, the association between anticholinergic drug use and functional status is still poorly investigated, particularly among subjects with initial cognitive impairment.

DESIGN

Cross-sectional study examining the association between drug-related anticholinergic burden and functional status in cognitively healthy (CH) (n=691), mild cognitive impairment (MCI) (n=541) or mild Alzheimer's diseases (AD) (n=1127) subjects.

SETTING

Data were gathered from the ReGAl project (Rete Geriatrica Alzheimer-Geriatric Network on Alzheimer's disease), a large longitudinal Italian multicentric clinical-based study, promoted by the Italian Society of Gerontology and Geriatrics (SIGG).

PARTICIPANTS

2359 outpatients, older than 65 years, admitted to memory clinics. The total sample size, estimated according to a global effect size of 25% with type I error of 0.05 and a power of 95% is 2010 subjects.

MEASUREMENT

Functional status was evaluated by the Katz Index of Independence in Activities of Daily Living (ADL) and the Lawton-Brody Instrumental Activities of Daily Living (IADL) scales. The drug-related anticholinergic burden was estimated by the Anticholinergic Risk Scale (ARS).

RESULTS

The 15.9 % (n=375) of total population used at least one drug with anticholinergic properties. Such a drug use was associated with partially dependence in ADL (OR:1.42, CI95%: 1.10-1.83; p=0.006), independently of gender, number of drugs, comorbidity index, presence of clinically relevant neuropsychiatric symptoms and adjusted MMSE. Anticholinergic drug use was associated with un-ability at each IADL task only in male MCI subjects, with significant impairment in shopping (p=0.011), and drug management (p=0.05).

CONCLUSIONS

The use of medications with anticholinergic properties is common among older persons cognitively health as well as with cognitive impairment. Our results suggest that the use of anticholinergic drugs is associated with functional impairment, especially in old age subjects with initial cognitive impairment. Minimizing anticholinergic burden should result in maintaining daily functioning, especially in a vulnerable population, such as MCI and mild AD.

Authors+Show Affiliations

Dr Virginia Boccardi, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, Italy. Phone number: +39 0755783524 Email address: virginia.boccardi@unipg.it.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28346565

Citation

Boccardi, V, et al. "Anticholinergic Burden and Functional Status in Older People With Cognitive Impairment: Results From the Regal Project." The Journal of Nutrition, Health & Aging, vol. 21, no. 4, 2017, pp. 389-396.
Boccardi V, Baroni M, Paolacci L, et al. Anticholinergic Burden and Functional Status in Older People with Cognitive Impairment: Results from the Regal Project. J Nutr Health Aging. 2017;21(4):389-396.
Boccardi, V., Baroni, M., Paolacci, L., Ercolani, S., Longo, A., Giordano, M., Ruggiero, C., & Mecocci, P. (2017). Anticholinergic Burden and Functional Status in Older People with Cognitive Impairment: Results from the Regal Project. The Journal of Nutrition, Health & Aging, 21(4), 389-396. https://doi.org/10.1007/s12603-016-0787-x
Boccardi V, et al. Anticholinergic Burden and Functional Status in Older People With Cognitive Impairment: Results From the Regal Project. J Nutr Health Aging. 2017;21(4):389-396. PubMed PMID: 28346565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anticholinergic Burden and Functional Status in Older People with Cognitive Impairment: Results from the Regal Project. AU - Boccardi,V, AU - Baroni,M, AU - Paolacci,L, AU - Ercolani,S, AU - Longo,A, AU - Giordano,M, AU - Ruggiero,C, AU - Mecocci,P, PY - 2017/3/28/entrez PY - 2017/3/28/pubmed PY - 2017/8/15/medline KW - Elderly KW - anticholinergic burden KW - cognitive impairment KW - drug KW - functional status SP - 389 EP - 396 JF - The journal of nutrition, health & aging JO - J Nutr Health Aging VL - 21 IS - 4 N2 - OBJECTIVE: The use of drugs with intrinsic anticholinergic properties is widespread among old age persons. A growing body of evidences suggest that a high anticholinergic burden is associated with physical and cognitive impairment. However, the association between anticholinergic drug use and functional status is still poorly investigated, particularly among subjects with initial cognitive impairment. DESIGN: Cross-sectional study examining the association between drug-related anticholinergic burden and functional status in cognitively healthy (CH) (n=691), mild cognitive impairment (MCI) (n=541) or mild Alzheimer's diseases (AD) (n=1127) subjects. SETTING: Data were gathered from the ReGAl project (Rete Geriatrica Alzheimer-Geriatric Network on Alzheimer's disease), a large longitudinal Italian multicentric clinical-based study, promoted by the Italian Society of Gerontology and Geriatrics (SIGG). PARTICIPANTS: 2359 outpatients, older than 65 years, admitted to memory clinics. The total sample size, estimated according to a global effect size of 25% with type I error of 0.05 and a power of 95% is 2010 subjects. MEASUREMENT: Functional status was evaluated by the Katz Index of Independence in Activities of Daily Living (ADL) and the Lawton-Brody Instrumental Activities of Daily Living (IADL) scales. The drug-related anticholinergic burden was estimated by the Anticholinergic Risk Scale (ARS). RESULTS: The 15.9 % (n=375) of total population used at least one drug with anticholinergic properties. Such a drug use was associated with partially dependence in ADL (OR:1.42, CI95%: 1.10-1.83; p=0.006), independently of gender, number of drugs, comorbidity index, presence of clinically relevant neuropsychiatric symptoms and adjusted MMSE. Anticholinergic drug use was associated with un-ability at each IADL task only in male MCI subjects, with significant impairment in shopping (p=0.011), and drug management (p=0.05). CONCLUSIONS: The use of medications with anticholinergic properties is common among older persons cognitively health as well as with cognitive impairment. Our results suggest that the use of anticholinergic drugs is associated with functional impairment, especially in old age subjects with initial cognitive impairment. Minimizing anticholinergic burden should result in maintaining daily functioning, especially in a vulnerable population, such as MCI and mild AD. SN - 1760-4788 UR - https://www.unboundmedicine.com/medline/citation/28346565/Anticholinergic_Burden_and_Functional_Status_in_Older_People_with_Cognitive_Impairment:_Results_from_the_Regal_Project_ L2 - https://doi.org/10.1007/s12603-016-0787-x DB - PRIME DP - Unbound Medicine ER -