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Anticholinergic load and delirium in end-of-life patients.
Eur J Clin Pharmacol. 2021 Mar 17 [Online ahead of print]EJ

Abstract

BACKGROUND

Delirium is a neuropsychiatric syndrome associated with negative outcomes, including worsening of cognitive and functional status and an increased burden on patients and caregivers. Medications with anticholinergic effect have been associated with delirium symptoms, but the relationship is still debated.

OBJECTIVE

To assess the relation between delirium and anticholinergic load according to the hypothesis that the cumulative anticholinergic burden increases the risk of delirium.

METHODS

This retrospective cross-sectional study was conducted in a sample of end-of-life patients in a hospice or living at home between February and August 2019. Delirium was diagnosed on admission using the 4 'A's Test (4AT) and each patient's anticholinergic burden was measured with the Anticholinergic Cognitive Burden (ACB) scale.

RESULTS

Of the 461 eligible for analysis, 124 (26.9%) had delirium. Anticholinergic medications were associated with an increased risk of delirium in univariate (OR (95% CI) 1.26 (1.16-1.38), p < 0.0001) and multivariate models adjusted for age, sex, dementia, tumors, Karnofsky Performance Status (KPS) score, days of palliative assistance, and setting (OR (95% CI) 1.16 (1.05-1.28), p < 0.0001). Patients with delirium had a greater anticholinergic burden than those without, with a dose-effect relationship between total ACB score and delirium. Patients who scored 4 or more had 2 or 3 times the risk of delirium than those not taking anticholinergic drugs. The dose-response relationship was maintained in the multivariate model.

CONCLUSIONS

Anticholinergic drugs may influence the development of delirium due to the cumulative effect of multiple medications with modest antimuscarinic activity.

Authors+Show Affiliations

Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy. luca.pasina@marionegri.it.Fondazione VIDAS, Milan, Italy.Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.Fondazione VIDAS, Milan, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33733683

Citation

Pasina, Luca, et al. "Anticholinergic Load and Delirium in End-of-life Patients." European Journal of Clinical Pharmacology, 2021.
Pasina L, Rizzi B, Nobili A, et al. Anticholinergic load and delirium in end-of-life patients. Eur J Clin Pharmacol. 2021.
Pasina, L., Rizzi, B., Nobili, A., & Recchia, A. (2021). Anticholinergic load and delirium in end-of-life patients. European Journal of Clinical Pharmacology. https://doi.org/10.1007/s00228-021-03125-w
Pasina L, et al. Anticholinergic Load and Delirium in End-of-life Patients. Eur J Clin Pharmacol. 2021 Mar 17; PubMed PMID: 33733683.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anticholinergic load and delirium in end-of-life patients. AU - Pasina,Luca, AU - Rizzi,Barbara, AU - Nobili,Alessandro, AU - Recchia,Angela, Y1 - 2021/03/17/ PY - 2020/12/04/received PY - 2021/03/12/accepted PY - 2021/3/18/entrez PY - 2021/3/19/pubmed PY - 2021/3/19/medline KW - Anticholinergic drugs KW - Delirium KW - Elderly KW - End-of-life JF - European journal of clinical pharmacology JO - Eur J Clin Pharmacol N2 - BACKGROUND: Delirium is a neuropsychiatric syndrome associated with negative outcomes, including worsening of cognitive and functional status and an increased burden on patients and caregivers. Medications with anticholinergic effect have been associated with delirium symptoms, but the relationship is still debated. OBJECTIVE: To assess the relation between delirium and anticholinergic load according to the hypothesis that the cumulative anticholinergic burden increases the risk of delirium. METHODS: This retrospective cross-sectional study was conducted in a sample of end-of-life patients in a hospice or living at home between February and August 2019. Delirium was diagnosed on admission using the 4 'A's Test (4AT) and each patient's anticholinergic burden was measured with the Anticholinergic Cognitive Burden (ACB) scale. RESULTS: Of the 461 eligible for analysis, 124 (26.9%) had delirium. Anticholinergic medications were associated with an increased risk of delirium in univariate (OR (95% CI) 1.26 (1.16-1.38), p < 0.0001) and multivariate models adjusted for age, sex, dementia, tumors, Karnofsky Performance Status (KPS) score, days of palliative assistance, and setting (OR (95% CI) 1.16 (1.05-1.28), p < 0.0001). Patients with delirium had a greater anticholinergic burden than those without, with a dose-effect relationship between total ACB score and delirium. Patients who scored 4 or more had 2 or 3 times the risk of delirium than those not taking anticholinergic drugs. The dose-response relationship was maintained in the multivariate model. CONCLUSIONS: Anticholinergic drugs may influence the development of delirium due to the cumulative effect of multiple medications with modest antimuscarinic activity. SN - 1432-1041 UR - https://www.unboundmedicine.com/medline/citation/33733683/Anticholinergic_load_and_delirium_in_end_of_life_patients_ L2 - https://dx.doi.org/10.1007/s00228-021-03125-w DB - PRIME DP - Unbound Medicine ER -
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