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Anticholinergic medications and Cognition

Richard J Holden, Preethi Srinivas, Noll L Campbell, Daniel O Clark, Kunal S Bodke, Youngbok Hong, Malaz A Boustani, Denisha Ferguson, Christopher M Callahan
BACKGROUND: Older adults purchase and use over-the-counter (OTC) medications with potentially significant adverse effects. Some OTC medications, such as those with anticholinergic effects, are relatively contraindicated for use by older adults due to evidence of impaired cognition and other adverse effects. OBJECTIVE: To inform the design of future OTC medication safety interventions for older adults, this study investigated consumers' decision making and behavior related to OTC medication purchasing and use, with a focus on OTC anticholinergic medications...
March 6, 2018: Research in Social & Administrative Pharmacy: RSAP
Martin M Limback-Stokin, Janina Krell-Roesch, Kimberly Roesler, Allison Hansen, Cynthia M Stonnington, M'hamed Temkit, Richard J Caselli, Yonas E Geda
No abstract text is available yet for this article.
February 23, 2018: Alzheimer Disease and Associated Disorders
Sarah A Morrow, Heather Rosehart, Alp Sener, Blayne Welk
Bladder dysfunction is common in persons with MS (PwMS), often due to detrusor muscle overactivity. Anticholinergic medications are considered the first line treatment for bladder dysfunction and are known to worsen cognition in healthy older adults and in persons with dementia. Yet, it is not known if these medications have the same effect on PwMS. Thus, the Objective of this prospective matched-cohort study was to determine if anticholinergic medications affect objective measures of cognition in PwMS. We recruited PwMS starting either oxybutynin or tolterodine (cases)...
February 15, 2018: Journal of the Neurological Sciences
Ariel R Green, Liza M Reifler, Cynthia M Boyd, Linda A Weffald, Elizabeth A Bayliss
BACKGROUND: Drugs with anticholinergic properties are considered potentially inappropriate in patients with cognitive impairment because harms-including delirium, falls, and fractures-may outweigh benefits. OBJECTIVE: To highlight opportunities to improve clinical decision making and care for patients with cognitive impairment and multiple chronic conditions, we identified distinct subgroups of patients with mild cognitive impairment (MCI) and dementia who had high cumulative anticholinergic burden and specific patterns of anticholinergic use...
February 5, 2018: Drugs & Aging
Shuichi Watanabe, Takahide Fukatsu, Kosuke Kanemoto
BACKGROUND: With the ageing of the general population, demand has grown for measures to prevent hospitalization for dementia, which can exacerbate problems associated with activities of daily living in elderly individuals. Anticholinergic medication has been shown to cause falls, delirium, and cognitive impairment in aged patients. However, the risk of hospitalization associated with the administration of anticholinergics is unclear. METHODS: We analyzed the records of 61 outpatients (26 men, 35 women; mean age: 78 ± 7 years; mean follow-up period: 420 days) diagnosed with dementia (Alzheimer's disease: n = 45; dementia with Lewy bodies: n = 3; undifferentiated n = 13) and prescribed anti-dementia drugs between May 2013 and December 2014...
January 2018: Psychogeriatrics: the Official Journal of the Japanese Psychogeriatric Society
Maria Gustafsson, Maria Sjölander, Bettina Pfister, Jörn Schneede, Hugo Lövheim
Age-associated physiological changes and extensive drug treatment including use of potentially inappropriate medications (PIMs) pose a significant risk of drug-drug interactions and adverse drug events among elderly people with dementia. This study aimed at analysing the effects of clinical pharmacists' interventions on use of PIMs, risk of emergency department visits, and time to institutionalization. Furthermore, a descriptive analysis was conducted of circumstances associated with drug-related readmissions...
January 16, 2018: Pharmacy (Basel, Switzerland)
Kahli Zietlow, Shelley R McDonald, Richard Sloane, Jeffrey Browndyke, Sandhya Lagoo-Deenadayalan, Mitchell T Heflin
OBJECTIVES: To compare postoperative outcomes of individuals with and without cognitive impairment enrolled in the Perioperative Optimization of Senior Health (POSH) program at Duke University, a comanagement model involving surgery, anesthesia, and geriatrics. DESIGN: Retrospective analysis of individuals enrolled in a quality improvement program. SETTING: Tertiary academic center. PARTICIPANTS: Older adults undergoing surgery and referred to POSH (N = 157)...
January 13, 2018: Journal of the American Geriatrics Society
Stephanie L Harrison, Lisa Kouladjian O'Donnell, Clare E Bradley, Rachel Milte, Suzanne M Dyer, Emmanuel S Gnanamanickam, Enwu Liu, Sarah N Hilmer, Maria Crotty
BACKGROUND: Inappropriate polypharmacy may negatively impact the quality of life of residents in aged care facilities, but it remains unclear which medications may influence this reduced quality of life. OBJECTIVE: The objective of this study was to examine whether the Drug Burden Index and potentially inappropriate medications were associated with quality of life in older adults living in residential care with a high prevalence of cognitive impairment and dementia...
January 2018: Drugs & Aging
Ulla Liisa Aalto, Hanna-Maria Roitto, Harriet Finne-Soveri, Hannu Kautiainen, Kaisu Pitkälä
OBJECTIVES: To assess the burden of drugs with anticholinergic properties (DAPs) and associated factors in long-term care facilities and to explore how psychological well-being and mortality are associated with the use of DAPs. DESIGN: Cross-sectional study and 1-year follow-up of all-cause mortality. SETTING AND PARTICIPANTS: All 4449 older people (>65 years of age) living in nursing homes and assisted living facilities in Helsinki in 2011 were recruited...
December 26, 2017: Journal of the American Medical Directors Association
Joshua Niznik, Xinhua Zhao, Tao Jiang, Joseph T Hanlon, Sherrie L Aspinall, Joshua Thorpe, Carolyn Thorpe
BACKGROUND: Prescribing of medications with anticholinergic properties in older nursing home residents is relatively common, despite an association with an increased risk for falls, delirium, and other outcomes. Few studies have investigated what factors influence different levels of prescribing of these agents. OBJECTIVES: The primary objective was to identify factors associated with low- and high-level anticholinergic burden in nursing home residents. A secondary objective was to examine in detail the contribution of different medications to low versus high burden to aid in determining which drugs to target in interventions...
December 2017: Drugs & Aging
Christopher Tsoutsoulas, Benoit H Mulsant, Sanjeev Kumar, Zaid Ghazala, Aristotle N Voineskos, Mahesh Menon, Bruce G Pollock, Tarek K Rajji
OBJECTIVE: Older individuals with schizophrenia are at risk of being treated with anticholinergic medications due to the prevalence of medical comorbidities and polypharmacy. High anticholinergic burden impairs cognition and is a risk factor for Alzheimer's dementia. Thus, we assessed the impact of anticholinergic burden on Alzheimer's dementia-related and schizophrenia-related cognitive functions in older patients with schizophrenia. METHODS: Anticholinergic burden was measured using the Anticholinergic Cognitive Burden scale (ACB) in 60 community-dwelling patients aged ≥ 50 years who met DSM-IV criteria for schizophrenia between May 2007 and November 2011...
November 2017: Journal of Clinical Psychiatry
John Heesakkers, Montserrat Espuña Pons, Philip Toozs Hobson, Emmanuel Chartier-Kastler
Overactive bladder (OAB) syndrome is a common, complex, and challenging condition. To assist the management of these patients, the European Association of Urology (EAU) updates its guidelines annually. This review reports the presentations from the symposium titled "Dealing with complex OAB patient profiles: in or out of the EAU guidelines?" held at the 32nd EAU Annual Congress in March 2017 in London. The symposium focused on three groups of OAB patients: women who may also suffer pelvic organ prolapse, stress urinary incontinence, the genitourinary syndrome of menopause (GSM); patients at risk of cognitive impairment; and elderly patients...
2017: Research and Reports in Urology
Ana M Lupu, Kimberly Clinebell, Jessica M Gannon, Justin C Ellison, K N Roy Chengappa
OBJECTIVE: Anticholinergic medications are prescribed to treat extrapyramidal side effects (EPS) associated with antipsychotics. Anticholinergic medications cause several side effects and can often be withdrawn during the maintenance phase of antipsychotic treatment without EPS reemergence. The purpose of this quality improvement (QI) project was to reduce anticholinergic medication burden and improve quality of life in patients with severe mental illness. METHODS: Patients with DSM-IV-TR-diagnosed schizophrenia, schizoaffective disorder, and bipolar disorders in an outpatient psychiatric clinic who were prescribed benztropine were identified, screened for anticholinergic side effects by the treating psychiatrist, and referred to an on-site clinical pharmacist for a comprehensive medication review...
November 2017: Journal of Clinical Psychiatry
Wen-Han Hsu, Yu-Wen Wen, Liang-Kung Chen, Fei-Yuan Hsiao
PURPOSE: No consensus has been reached regarding which anticholinergic scoring system works most effectively in clinical settings. The aim of this population-based cohort study was to examine the association between anticholinergic medication burden, as defined by different scales, and adverse clinical outcomes among older adults. METHODS: From Taiwan's Longitudinal Health Insurance Database, we retrieved data on monthly anticholinergic drug use measured by the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden Scale (ACB), and the Drug Burden Index - Anticholinergic component (DBI-Ach) for 116,043 people aged 65 years and older during a 10-year follow-up...
November 2017: Annals of Family Medicine
Kenya Ie, Eric Chou, Richard D Boyce, Steven M Albert
BACKGROUND: Several scales to quantify the impact of potentially harmful medications (PHMs) have been shown to predict mortality and functional decline; however, the effect of PHMs on quality of life (QoL) has not been well-studied. OBJECTIVE: The aims of this study were to investigate an association between PHM use and change in health-related QoL among community-dwelling older adults, and to compare the predictive capacity of PHM scales. METHODS: We conducted a retrospective cohort study using prescription claims data and survey responses...
December 2017: Drugs—Real World Outcomes
Yi-Fang Chuang, Palchamy Elango, Christopher E Gonzalez, Madhav Thambisetty
INTRODUCTION: We examined how long-term anticholinergic (AC) drug use beginning at midlife affects risk of Alzheimer's disease (AD) and rates of brain atrophy in cognitively normal older adults. METHODS: We followed 723 individuals (mean baseline age 52.3 years; mean follow-up interval 20.1 years) in the Baltimore Longitudinal Study of Aging. The AC drug exposure was defined using the Anticholinergic Cognitive Burden Scale: Nonusers (n = 404), as well as participants exposed to medications with AC activity but without known clinically relevant negative cognitive effects (i...
September 2017: Alzheimer's & Dementia: Translational Research & Clinical Interventions
Mei San Ang, Nur Amirah Abdul Rashid, Max Lam, Attilio Rapisarda, Michael Kraus, Richard S E Keefe, Jimmy Lee
BACKGROUND: Cognitive deficits are prevalent in people with schizophrenia and associated with functional impairments. In addition to antipsychotics, pharmacotherapy in schizophrenia often includes other psychotropics, and some of these agents possess anticholinergic properties, which may impair cognition. The objective of this study was to explore the association between medication anticholinergic burden and cognition in schizophrenia. METHODS: Seven hundred five individuals with schizophrenia completed a neuropsychological battery comprising Judgment of Line Orientation Test, Wechsler Abbreviated Scale of Intelligence Matrix Reasoning, Continuous Performance Test-Identical Pairs Version, and the Brief Assessment of Cognition in Schizophrenia...
December 2017: Journal of Clinical Psychopharmacology
Kathrin Heser, Tobias Luck, Susanne Röhr, Birgitt Wiese, Hanna Kaduszkiewicz, Anke Oey, Horst Bickel, Edelgard Mösch, Siegfried Weyerer, Jochen Werle, Christian Brettschneider, Hans-Helmut König, Angela Fuchs, Michael Pentzek, Hendrik van den Bussche, Martin Scherer, Wolfgang Maier, Steffi G Riedel-Heller, Michael Wagner
BACKGROUND: Potentially inappropriate medication (PIM) is associated with an increased risk for detrimental health outcomes in elderly patients. Some antidepressant drugs are considered as PIM, but previous research on the association between antidepressants and subsequent dementia has been inconclusive. Therefore, we investigated whether the intake of antidepressants, particularly of those considered as PIM according to the Priscus list, would predict incident dementia. METHODS: We used data of a prospective cohort study of non-demented primary care patients (n = 3239, mean age = 79...
September 14, 2017: Journal of Affective Disorders
George Araklitis, Linda Cardozo
The mainstay of overactive bladder treatment is the use of anticholinergic medication with its common side effects well known. This review focused on three less well-known safety issues when treating OAB. Areas covered: Patients with increased anticholinergic load are at risk of cognitive decline, dementia or even death. The elderly are particularly at risk due to polypharmacy. Botulinum toxin carries the risk of high urinary residuals, urinary tract infection and need to self catheterise. The use of vaginal oestrogens may improve OAB symptoms, but there is concern in those with a history of breast cancer...
November 2017: Expert Opinion on Drug Safety
Amanda J Cross, Johnson George, Michael C Woodward, David Ames, Henry Brodaty, Rory Wolfe, Michael H Connors, Rohan A Elliott
BACKGROUND: There is limited evidence regarding the association between potentially inappropriate medications (PIM) and mortality in older people with cognitive impairment. OBJECTIVE: To examine whether use of medications considered to be potentially inappropriate in older people with cognitive impairment (PIMcog) and anticholinergic cognitive burden (ACB) were associated with mortality in people who attended memory clinics. METHODS: Cross-sectional and longitudinal analyses of data from the Prospective Research In MEmory clinics (PRIME) study...
2017: Journal of Alzheimer's Disease: JAD
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