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Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study.
BMC Geriatr. 2022 10 06; 22(1):783.BG

Abstract

BACKGROUND

Anticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission.

METHODS

We included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient's medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon's rank test was used to look at the correlation between two subgroups upon admission and discharge.

RESULTS

On admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant (p = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications.

CONCLUSIONS

Our cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission.

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Authors+Show Affiliations

Hook A
Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK. annabelle.hook@nhs.net. Great Western Hospital, Marlborough Road, Swindon, SN3 6BB, UK. annabelle.hook@nhs.net.
Randall JL
Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK.
Grubb CM
Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK. Betsi Cadwaladr University Health Board, Bangor, LL57 2PW, UK.
Ellis N
Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK. Withybush Hospital, Fishguard Road, Haverfordwest, SA61 2PZ, UK.
Wellington J
Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK.
Hemmad A
The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
Zerdelis A
The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK. University Hospital of Wales, Heath Park Way, Cardiff, CF14 4XW, UK.
Winnett ARD
Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London, EN11 1NR, UK.
Geers BDW
School of Medicine, University of Manchester, Manchester, M13 9PL, UK.
Sykes B
University of Exeter Medical School, Heavitree Road, Exeter, EX1 2LU, UK.
Auty CN
School of Medicine, University of Manchester, Manchester, M13 9PL, UK. Queen's Medical Centre Nottingham, Clifton Boulevard, Derby Road, Nottingham, NG7 2UH, UK.
Vinchenzo C
Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Furness Building, Lancaster, LA1 4YG, UK.
Thorburn CE
Bristol Medical School, University of Bristol, First Floor, 5 Tyndall Avenue, Bristol, BS8 1UD, UK.
Asogbon D
Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Granger E
University Hospitals of Morecambe Bay NHS Foundation Trust, Burton Road, Kendal, LA9 7RG, UK. Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Fulwood, Preston, Lancashire, PR2 9HT, UK.
Boagey H
Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
Raphael J
Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK.
Patel K
School of Medicine, University of Manchester, Manchester, M13 9PL, UK.
Bhargava K
The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
Dolley MM
Peninsula Medical School, The Faculty of Medicine and Dentistry, The John Bull Building, Plymouth Science Park, Research Way, Plymouth, PL6 8BU, UK.
Maden MJ
School of Medicine, University of Manchester, Manchester, M13 9PL, UK.
Shah MM
Bart's and The London School of Medicine and Dentistry, Queen Mary's University of London, Garrod Building, Turner Street, Whitechapel, London, E1 2AD, UK.
Lee QM
Bart's and The London School of Medicine and Dentistry, Queen Mary's University of London, Garrod Building, Turner Street, Whitechapel, London, E1 2AD, UK.
Vaidya R
The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
Sehdev S
Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ, UK.
Barai S
School of Clinical Medicine, University of Cambridge, Box 111, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK. Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough, PE3 9GZ, UK.
Roche S
Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
Khalid U
University College London Medical School, 74 Huntley St, Bloomsbury, London, WC1E 6DE, UK. St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK.
Codling DA
King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
Harrison JR
Biomedical Research Building Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK. Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Maindy Road, Cardiff, CF24 4HQ, UK.

MeSH

AgedCholinergic AntagonistsCholinesterase InhibitorsCross-Sectional StudiesDementiaHospitalsHumans

Pub Type(s)

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

Language

eng

PubMed ID

36203156

Citation

Hook, Annabelle, et al. "Anti-cholinergic Drug Burden in Patients With Dementia Increases After Hospital Admission: a Multicentre Cross-sectional Study." BMC Geriatrics, vol. 22, no. 1, 2022, p. 783.
Hook A, Randall JL, Grubb CM, et al. Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study. BMC Geriatr. 2022;22(1):783.
Hook, A., Randall, J. L., Grubb, C. M., Ellis, N., Wellington, J., Hemmad, A., Zerdelis, A., Winnett, A. R. D., Geers, B. D. W., Sykes, B., Auty, C. N., Vinchenzo, C., Thorburn, C. E., Asogbon, D., Granger, E., Boagey, H., Raphael, J., Patel, K., Bhargava, K., ... Harrison, J. R. (2022). Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study. BMC Geriatrics, 22(1), 783. https://doi.org/10.1186/s12877-022-03235-9
Hook A, et al. Anti-cholinergic Drug Burden in Patients With Dementia Increases After Hospital Admission: a Multicentre Cross-sectional Study. BMC Geriatr. 2022 10 6;22(1):783. PubMed PMID: 36203156.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study. AU - Hook,Annabelle, AU - Randall,Jessica L, AU - Grubb,Carla M, AU - Ellis,Natalie, AU - Wellington,Jack, AU - Hemmad,Aayushi, AU - Zerdelis,Agisilaos, AU - Winnett,Andrew R D, AU - Geers,Benjamin D W, AU - Sykes,Bethany, AU - Auty,Charlotte N, AU - Vinchenzo,Cecilia, AU - Thorburn,Christiane E, AU - Asogbon,Daniella, AU - Granger,Emily, AU - Boagey,Heather, AU - Raphael,Juliet, AU - Patel,Kajal, AU - Bhargava,Kartik, AU - Dolley,Mary-Kate M, AU - Maden,Matthew J, AU - Shah,Mehdin M, AU - Lee,Qao M, AU - Vaidya,Ratnaraj, AU - Sehdev,Simran, AU - Barai,Sneha, AU - Roche,Sophie, AU - Khalid,Uzair, AU - Codling,David A, AU - Harrison,Judith R, Y1 - 2022/10/06/ PY - 2021/09/09/received PY - 2022/05/09/accepted PY - 2022/10/6/entrez PY - 2022/10/7/pubmed PY - 2022/10/12/medline KW - Alzheimer disease KW - Antidepressive agents KW - Antipsychotic agents KW - Cholinesterase inhibitors KW - Cognition KW - Cognitive dysfunction KW - Dementia KW - Memory disorders KW - Muscarinic antagonists KW - Polypharmacy SP - 783 EP - 783 JF - BMC geriatrics JO - BMC Geriatr VL - 22 IS - 1 N2 - BACKGROUND: Anticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission. METHODS: We included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient's medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon's rank test was used to look at the correlation between two subgroups upon admission and discharge. RESULTS: On admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant (p = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications. CONCLUSIONS: Our cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission. SN - 1471-2318 UR - https://www.unboundmedicine.com/medline/citation/36203156/Anti_cholinergic_drug_burden_in_patients_with_dementia_increases_after_hospital_admission:_a_multicentre_cross_sectional_study_ DB - PRIME DP - Unbound Medicine ER -