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Anticholinergic burden of patients with dementia attending a Psychiatry of Later Life service

Published online by Cambridge University Press:  21 May 2019

R. M. Vaughan Open the ORCID record for R. M. Vaughan [Opens in a new window] ,
R. Flynn  and
N. Greene
R. M. Vaughan*
Affiliation:
Psychiatry of Later Life, Tallaght University Hospital, Dublin 24, Ireland
R. Flynn
Affiliation:
Psychiatry of Later Life and School of Medicine, Trinity College Dublin, Dublin, Ireland
N. Greene
Affiliation:
Psychiatry of Later Life, Tallaght University Hospital, Dublin 24, Ireland
*
*Address for correspondence: Dr R. M. Vaughan, Psychiatry of Later Life, Tallaght University Hospital, Dublin 24, Ireland. (Email: roisvaughan@gmail.com)
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Abstract

Objectives

Older adults with dementia are particularly vulnerable to adverse outcomes resulting from anticholinergic use. We aimed to: (i) Examine the anticholinergic burden of patients with dementia attending a Psychiatry of Later Life (PLL) service (ii) Examine concomitant prescription of acetylcholinesterase inhibitors (AChEIs) and anticholinergics and (iii) Compare the Anticholinergic Cognitive Burden (ACB) scale with a recently published composite list of anticholinergics.

Methods

Retrospective chart review of new referrals with a diagnosis of dementia (n = 66) seen by the PLL service, Tallaght University Hospital, Dublin, Ireland, over a consecutive period of 4 months.

Results

The mean ACB score was 2.2 (range = 0–9, SD = 2.1). 37.9% (n = 25) had a clinically significant ACB score (>3) and 42.1% (n = 8) of those taking AChEIs had a clinically significant ACB score. A significantly greater number of medications with anticholinergic activity were identified using the composite list versus the traditional ACB scale (2.3 v.1.5, p = 0.001).

Conclusions

We demonstrated a significant anticholinergic burden amongst patients with dementia attending a specialist PLL service. There was no difference in anticholinergic burden between groups prescribed and not prescribed AChEIs, indicating that these medications are being prescribed without discontinuation of potentially inappropriate medications with anticholinergic activity. The true anticholinergic burden experienced by patients may be underestimated by the use of the ACB score alone, although the clinical significance of this finding is unclear. Calculation of true clinical anticholinergic burden load and its translation to a specific rating scale remains a challenge.

Keywords

Acetylcholinesteraseanticholinergicdementiaolder adults
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 39 , Issue 1 , March 2022 , pp. 39 - 44
Copyright
© The Author(s), 2019. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland

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