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Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population-based study.
Basic Clin Pharmacol Toxicol. 2019 Jun; 124(6):741-748.BC

Abstract

Few studies have evaluated the association between anticholinergic burden and treatment modification after starting a cholinesterase inhibitor in clinical practice. We aimed to evaluate the effect of anticholinergic burden on anti-dementia treatment modification, delirium and mortality. We retrospectively analysed older adults (n = 25 825) who started a cholinesterase inhibitor during 2003-2011 from Korean National Health Insurance Service Senior Cohort Database. High anticholinergic burden was defined as an average daily Anticholinergic Cognitive Burden (ACB) score of >3 during the first 3 months. We investigated the impact of high anticholinergic burden on the rate of treatment modification, delirium and mortality in comparison with minimal ACB (ACB score ≤1) in propensity-matched cohorts (N = 7438). Approximately 6.0% of patients with dementia were exposed to a high anticholinergic burden within the first three months of treatment. In high anticholinergic burden cohorts, significantly more patients experienced treatment modification (34.9% vs. 32.1%) or delirium (5.6% vs. 3.6%) and the mortality rate was also higher (16.8% vs. 14.1%) than controls. A multivariate Cox proportional hazard regression analysis showed that an average ACB score >3 within the first three months significantly increased the risk of treatment modification (hazard ratio (HR): 1.12, 95% confidence interval (CI): 1.02-1.24), delirium (HR: 1.52, CI: 1.17-1.96) and mortality (HR: 1.23, CI: 1.06-1.41). This study showed that high anticholinergic burden negatively affected the treatment response to cholinesterase inhibitors and that an average ACB score >3 was an independent prognostic factor for delirium or mortality in dementia patients.

Authors+Show Affiliations

College of Pharmacy, Yeungnam University, Gyeongsangbuk-do, Korea.College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea.College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea.College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Korea.College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30511428

Citation

Ah, Young-Mi, et al. "Effect of Anticholinergic Burden On Treatment Modification, Delirium and Mortality in Newly Diagnosed Dementia Patients Starting a Cholinesterase Inhibitor: a Population-based Study." Basic & Clinical Pharmacology & Toxicology, vol. 124, no. 6, 2019, pp. 741-748.
Ah YM, Suh Y, Jun K, et al. Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population-based study. Basic Clin Pharmacol Toxicol. 2019;124(6):741-748.
Ah, Y. M., Suh, Y., Jun, K., Hwang, S., & Lee, J. Y. (2019). Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population-based study. Basic & Clinical Pharmacology & Toxicology, 124(6), 741-748. https://doi.org/10.1111/bcpt.13184
Ah YM, et al. Effect of Anticholinergic Burden On Treatment Modification, Delirium and Mortality in Newly Diagnosed Dementia Patients Starting a Cholinesterase Inhibitor: a Population-based Study. Basic Clin Pharmacol Toxicol. 2019;124(6):741-748. PubMed PMID: 30511428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population-based study. AU - Ah,Young-Mi, AU - Suh,Yewon, AU - Jun,Kwanghee, AU - Hwang,Sunghee, AU - Lee,Ju-Yeun, Y1 - 2019/01/10/ PY - 2018/09/17/received PY - 2018/11/28/accepted PY - 2018/12/5/pubmed PY - 2019/12/18/medline PY - 2018/12/5/entrez KW - Alzheimer’s disease KW - anticholinergics KW - cholinesterase inhibitors KW - delirium KW - mortality SP - 741 EP - 748 JF - Basic & clinical pharmacology & toxicology JO - Basic Clin Pharmacol Toxicol VL - 124 IS - 6 N2 - Few studies have evaluated the association between anticholinergic burden and treatment modification after starting a cholinesterase inhibitor in clinical practice. We aimed to evaluate the effect of anticholinergic burden on anti-dementia treatment modification, delirium and mortality. We retrospectively analysed older adults (n = 25 825) who started a cholinesterase inhibitor during 2003-2011 from Korean National Health Insurance Service Senior Cohort Database. High anticholinergic burden was defined as an average daily Anticholinergic Cognitive Burden (ACB) score of >3 during the first 3 months. We investigated the impact of high anticholinergic burden on the rate of treatment modification, delirium and mortality in comparison with minimal ACB (ACB score ≤1) in propensity-matched cohorts (N = 7438). Approximately 6.0% of patients with dementia were exposed to a high anticholinergic burden within the first three months of treatment. In high anticholinergic burden cohorts, significantly more patients experienced treatment modification (34.9% vs. 32.1%) or delirium (5.6% vs. 3.6%) and the mortality rate was also higher (16.8% vs. 14.1%) than controls. A multivariate Cox proportional hazard regression analysis showed that an average ACB score >3 within the first three months significantly increased the risk of treatment modification (hazard ratio (HR): 1.12, 95% confidence interval (CI): 1.02-1.24), delirium (HR: 1.52, CI: 1.17-1.96) and mortality (HR: 1.23, CI: 1.06-1.41). This study showed that high anticholinergic burden negatively affected the treatment response to cholinesterase inhibitors and that an average ACB score >3 was an independent prognostic factor for delirium or mortality in dementia patients. SN - 1742-7843 UR - https://www.unboundmedicine.com/medline/citation/30511428/Effect_of_anticholinergic_burden_on_treatment_modification_delirium_and_mortality_in_newly_diagnosed_dementia_patients_starting_a_cholinesterase_inhibitor:_A_population_based_study_ L2 - https://doi.org/10.1111/bcpt.13184 DB - PRIME DP - Unbound Medicine ER -