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Anticholinergic drug burden according to the anticholinergic drug scale and the German anticholinergic burden and their impact on cognitive function in multimorbid elderly German people: a multicentre observational study.
BMJ Open. 2021 03 23; 11(3):e044230.BO

Abstract

OBJECTIVES

The aims of our study were to examine the anticholinergic drug use and to assess the association between anticholinergic burden and cognitive function in the multimorbid elderly patients of the MultiCare cohort.

SETTING

MultiCare was conducted as a longitudinal cohort study in primary care, located in eight different study centres in Germany.

PARTICIPANTS

3189 patients (59.3% female).

PRIMARY AND SECONDARY OUTCOME MEASURES

Baseline data were used for the following analyses. Drugs were classified according to the well-established anticholinergic drug scale (ADS) and the recently published German anticholinergic burden (German ACB). Cognitive function was measured using a letter digit substitution test (LDST) and a mixed-effect multivariate linear regression was performed to calculate the influence of anticholinergic burden on the cognitive function.

RESULTS

Patients used 1764 anticholinergic drugs according to ADS and 2750 anticholinergics according to the German ACB score (prevalence 38.4% and 53.7%, respectively). The mean ADS score was 0.8 (±1.3), and the mean German ACB score was 1.2 (±1.6) per patient. The most common ADS anticholinergic was furosemide (5.8%) and the most common ACB anticholinergic was metformin (13.7%). The majority of the identified anticholinergics were drugs with low anticholinergic potential: 80.2% (ADS) and 73.4% (ACB), respectively. An increasing ADS and German ACB score was associated with reduced cognitive function according to the LDST (-0.26; p=0.008 and -0.24; p=0.003, respectively).

CONCLUSION

Multimorbid elderly patients are in a high risk for using anticholinergic drugs according to ADS and German ACB score. We especially need to gain greater awareness for the contribution of drugs with low anticholinergic potential from the cardiovascular system. As anticholinergic drug use is associated with reduced cognitive function in multimorbid elderly patients, the importance of rational prescribing and also deprescribing needs to be further evaluated.

TRIAL REGISTRATION NUMBER

ISRCTN89818205.

Authors+Show Affiliations

Department of Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany c.krueger@uke.de.Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Psychiatry, Technical University of Munich, Munich, Germany.Institute of General Practice, Heinrich Heine University Düsseldorf, Dusseldorf, Germany.Institute of General Practice and Family Medicine, Ludwig-Maximilians-Universitat Munich, Munich, Germany. Institut for General Practice, Jena University Hospital, Jena, Germany.Department for Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany.Institute for Social Medicine, Leipzig University, Leipzig, Germany.Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Medical Faculty Mannheim/Heidelberg, Central Institute of Mental Health, Mannheim, Germany.Institute for General Practice, Hannover Medical School, Hannover, Germany.Department of Research, Albertinen-Haus Zentrum fur Geriatrie und Gerontologie Medizinisch-Geriatrische Klinik, Hamburg, Germany.Department of Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Pub Type(s)

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

Language

eng

PubMed ID

33757948

Citation

Krüger, Caroline, et al. "Anticholinergic Drug Burden According to the Anticholinergic Drug Scale and the German Anticholinergic Burden and Their Impact On Cognitive Function in Multimorbid Elderly German People: a Multicentre Observational Study." BMJ Open, vol. 11, no. 3, 2021, pp. e044230.
Krüger C, Schäfer I, van den Bussche H, et al. Anticholinergic drug burden according to the anticholinergic drug scale and the German anticholinergic burden and their impact on cognitive function in multimorbid elderly German people: a multicentre observational study. BMJ Open. 2021;11(3):e044230.
Krüger, C., Schäfer, I., van den Bussche, H., Bickel, H., Fuchs, A., Gensichen, J., König, H. H., Maier, W., Mergenthal, K., Riedel-Heller, S. G., Schön, G., Weyerer, S., Wiese, B., von Renteln-Kruse, W., Langebrake, C., & Scherer, M. (2021). Anticholinergic drug burden according to the anticholinergic drug scale and the German anticholinergic burden and their impact on cognitive function in multimorbid elderly German people: a multicentre observational study. BMJ Open, 11(3), e044230. https://doi.org/10.1136/bmjopen-2020-044230
Krüger C, et al. Anticholinergic Drug Burden According to the Anticholinergic Drug Scale and the German Anticholinergic Burden and Their Impact On Cognitive Function in Multimorbid Elderly German People: a Multicentre Observational Study. BMJ Open. 2021 03 23;11(3):e044230. PubMed PMID: 33757948.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anticholinergic drug burden according to the anticholinergic drug scale and the German anticholinergic burden and their impact on cognitive function in multimorbid elderly German people: a multicentre observational study. AU - Krüger,Caroline, AU - Schäfer,Ingmar, AU - van den Bussche,Hendrik, AU - Bickel,Horst, AU - Fuchs,Angela, AU - Gensichen,Jochen, AU - König,Hans-Helmut, AU - Maier,Wolfgang, AU - Mergenthal,Karola, AU - Riedel-Heller,Steffi G, AU - Schön,Gerhard, AU - Weyerer,Siegfried, AU - Wiese,Birgitt, AU - von Renteln-Kruse,Wolfgang, AU - Langebrake,Claudia, AU - Scherer,Martin, Y1 - 2021/03/23/ PY - 2021/3/24/entrez PY - 2021/3/25/pubmed PY - 2021/5/20/medline KW - clinical pharmacology KW - epidemiology KW - primary care SP - e044230 EP - e044230 JF - BMJ open JO - BMJ Open VL - 11 IS - 3 N2 - OBJECTIVES: The aims of our study were to examine the anticholinergic drug use and to assess the association between anticholinergic burden and cognitive function in the multimorbid elderly patients of the MultiCare cohort. SETTING: MultiCare was conducted as a longitudinal cohort study in primary care, located in eight different study centres in Germany. PARTICIPANTS: 3189 patients (59.3% female). PRIMARY AND SECONDARY OUTCOME MEASURES: Baseline data were used for the following analyses. Drugs were classified according to the well-established anticholinergic drug scale (ADS) and the recently published German anticholinergic burden (German ACB). Cognitive function was measured using a letter digit substitution test (LDST) and a mixed-effect multivariate linear regression was performed to calculate the influence of anticholinergic burden on the cognitive function. RESULTS: Patients used 1764 anticholinergic drugs according to ADS and 2750 anticholinergics according to the German ACB score (prevalence 38.4% and 53.7%, respectively). The mean ADS score was 0.8 (±1.3), and the mean German ACB score was 1.2 (±1.6) per patient. The most common ADS anticholinergic was furosemide (5.8%) and the most common ACB anticholinergic was metformin (13.7%). The majority of the identified anticholinergics were drugs with low anticholinergic potential: 80.2% (ADS) and 73.4% (ACB), respectively. An increasing ADS and German ACB score was associated with reduced cognitive function according to the LDST (-0.26; p=0.008 and -0.24; p=0.003, respectively). CONCLUSION: Multimorbid elderly patients are in a high risk for using anticholinergic drugs according to ADS and German ACB score. We especially need to gain greater awareness for the contribution of drugs with low anticholinergic potential from the cardiovascular system. As anticholinergic drug use is associated with reduced cognitive function in multimorbid elderly patients, the importance of rational prescribing and also deprescribing needs to be further evaluated. TRIAL REGISTRATION NUMBER: ISRCTN89818205. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/33757948/Anticholinergic_drug_burden_according_to_the_anticholinergic_drug_scale_and_the_German_anticholinergic_burden_and_their_impact_on_cognitive_function_in_multimorbid_elderly_German_people:_a_multicentre_observational_study_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=33757948 DB - PRIME DP - Unbound Medicine ER -