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Association of Anticholinergic Drug Burden with Cognitive and Functional Decline Over Time in Older Inpatients: Results from the CRIME Project.
Drugs Aging. 2018 10; 35(10):917-924.DA

Abstract

BACKGROUND

Medications with anticholinergic properties, although widely used, may negatively affect cognitive and functional status in older patients. To date there is still no standardized method to quantify anticholinergic exposure. We analyzed the relationship of two different tools for the evaluation of the anticholinergic drug burden with cognitive and functional impairment in a sample of older hospitalized patients.

METHODS

A retrospective and longitudinal analysis with 1-year follow-up of 1123 older hospitalized patients enrolled in seven Italian acute care wards was conducted. We assessed anticholinergic burden with the Anticholinergic Cognitive Burden (ACB) and Anticholinergic Risk Scale (ARS). Cognitive and functional status were evaluated at hospital discharge and during follow-up (3, 6, 12 months) using the Mini Mental State Examination (MMSE) and five basic activities of daily living (ADLs). Associations between anticholinergic burden and cognitive decline and incident disability were estimated using linear regression models for repeated measures and logistic models, respectively.

RESULTS

The mean age of the study population was 81 ± 7.5 years. ACB and ARS classifications showed low correlation (Spearman's rho = 0.39-0.43). Anticholinergic burden increased during hospitalization and was associated with cognitive and functional status. Patients with an ARS of ≥ 1 at discharge had significantly lower baseline MMSE scores (ARS = 0: 23.1; ARS ≥ 1: 20.8; p = 0.002) and during follow-up presented a significantly steeper MMSE score decline (- 0.15/month). Moreover, patients with an ACB of ≥ 1 at discharge had an almost threefold increased risk of developing disability (odds ratio 2.77, 95% confidence interval 1.39-5.54).

CONCLUSIONS

ACB and ARS have only a moderate degree of correlation. Use of drugs with anticholinergic properties in elderly patients is independently associated with cognitive and functional decline.

Authors+Show Affiliations

Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Via Aldo Moro no 8, 44124, Ferrara, Italy. g.brombo@gmail.com.Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Via Aldo Moro no 8, 44124, Ferrara, Italy.Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Via Aldo Moro no 8, 44124, Ferrara, Italy.Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Via Aldo Moro no 8, 44124, Ferrara, Italy.Unit of Geriatric Pharmacoepidemiology, Italian National Research Center on Aging (INRCA), Contrada Muoio Piccolo, Cosenza, Italy.Geriatrics and Geriatrics Emergency Care, Italian National Research Center on Aging (INRCA), Via della Montagnola 81, Ancona, Italy.Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Piazzale Gambuli 1, Perugia, Italy.Department of Gerontology, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Gemelli University Hospital, Largo Francesco Vito 1, Rome, Italy.Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Via Aldo Moro no 8, 44124, Ferrara, Italy.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30191516

Citation

Brombo, Gloria, et al. "Association of Anticholinergic Drug Burden With Cognitive and Functional Decline Over Time in Older Inpatients: Results From the CRIME Project." Drugs & Aging, vol. 35, no. 10, 2018, pp. 917-924.
Brombo G, Bianchi L, Maietti E, et al. Association of Anticholinergic Drug Burden with Cognitive and Functional Decline Over Time in Older Inpatients: Results from the CRIME Project. Drugs Aging. 2018;35(10):917-924.
Brombo, G., Bianchi, L., Maietti, E., Malacarne, F., Corsonello, A., Cherubini, A., Ruggiero, C., Onder, G., & Volpato, S. (2018). Association of Anticholinergic Drug Burden with Cognitive and Functional Decline Over Time in Older Inpatients: Results from the CRIME Project. Drugs & Aging, 35(10), 917-924. https://doi.org/10.1007/s40266-018-0584-9
Brombo G, et al. Association of Anticholinergic Drug Burden With Cognitive and Functional Decline Over Time in Older Inpatients: Results From the CRIME Project. Drugs Aging. 2018;35(10):917-924. PubMed PMID: 30191516.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Anticholinergic Drug Burden with Cognitive and Functional Decline Over Time in Older Inpatients: Results from the CRIME Project. AU - Brombo,Gloria, AU - Bianchi,Lara, AU - Maietti,Elisa, AU - Malacarne,Francesca, AU - Corsonello,Andrea, AU - Cherubini,Antonio, AU - Ruggiero,Carmelinda, AU - Onder,Graziano, AU - Volpato,Stefano, PY - 2018/9/8/pubmed PY - 2018/12/12/medline PY - 2018/9/8/entrez SP - 917 EP - 924 JF - Drugs & aging JO - Drugs Aging VL - 35 IS - 10 N2 - BACKGROUND: Medications with anticholinergic properties, although widely used, may negatively affect cognitive and functional status in older patients. To date there is still no standardized method to quantify anticholinergic exposure. We analyzed the relationship of two different tools for the evaluation of the anticholinergic drug burden with cognitive and functional impairment in a sample of older hospitalized patients. METHODS: A retrospective and longitudinal analysis with 1-year follow-up of 1123 older hospitalized patients enrolled in seven Italian acute care wards was conducted. We assessed anticholinergic burden with the Anticholinergic Cognitive Burden (ACB) and Anticholinergic Risk Scale (ARS). Cognitive and functional status were evaluated at hospital discharge and during follow-up (3, 6, 12 months) using the Mini Mental State Examination (MMSE) and five basic activities of daily living (ADLs). Associations between anticholinergic burden and cognitive decline and incident disability were estimated using linear regression models for repeated measures and logistic models, respectively. RESULTS: The mean age of the study population was 81 ± 7.5 years. ACB and ARS classifications showed low correlation (Spearman's rho = 0.39-0.43). Anticholinergic burden increased during hospitalization and was associated with cognitive and functional status. Patients with an ARS of ≥ 1 at discharge had significantly lower baseline MMSE scores (ARS = 0: 23.1; ARS ≥ 1: 20.8; p = 0.002) and during follow-up presented a significantly steeper MMSE score decline (- 0.15/month). Moreover, patients with an ACB of ≥ 1 at discharge had an almost threefold increased risk of developing disability (odds ratio 2.77, 95% confidence interval 1.39-5.54). CONCLUSIONS: ACB and ARS have only a moderate degree of correlation. Use of drugs with anticholinergic properties in elderly patients is independently associated with cognitive and functional decline. SN - 1179-1969 UR - https://www.unboundmedicine.com/medline/citation/30191516/Association_of_Anticholinergic_Drug_Burden_with_Cognitive_and_Functional_Decline_Over_Time_in_Older_Inpatients:_Results_from_the_CRIME_Project_ L2 - https://dx.doi.org/10.1007/s40266-018-0584-9 DB - PRIME DP - Unbound Medicine ER -