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Cumulative Anticholinergic Exposure

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https://www.readbyqxmd.com/read/30221747/cumulative-antidepressant-use-and-risk-of-dementia-in-a-prospective-cohort-study
#1
Laura Heath, Shelly L Gray, Denise M Boudreau, Ken Thummel, Karen L Edwards, Stephanie M Fullerton, Paul K Crane, Eric B Larson
OBJECTIVES: To determine whether antidepressant use is associated with dementia risk. DESIGN: Prospective cohort study. SETTING: Kaiser Permanente Washington (KPWA), an integrated healthcare delivery system. PARTICIPANTS: Community-dwelling individuals aged 65 and older without dementia and with 10 years or more of KPWA enrollment at baseline (N=3,059). MEASUREMENTS: Primary exposures were selective serotonin reuptake inhibitors (paroxetine vs other), tricyclic antidepressants, and serotonin antagonist and reuptake inhibitors...
September 17, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/30196250/anticholinergic-drug-use-and-cognitive-performances-in-middle-age-findings-from-the-constances-cohort
#2
Abdelkrim Ziad, Romain Olekhnovitch, Fabrice Ruiz, Claudine Berr, Bernard Bégaud, Marcel Goldberg, Marie Zins, Thibault Mura
BACKGROUND: Previous studies have shown associations between the use of anticholinergics (AC) and cognitive performance in the elderly, considering AC as a homogeneous set of drugs. The present study aims to assess the relationship between exposure to AC drugs and cognitive performance in middle-aged adults according to AC potency and drug class. METHODS: Our cross-sectional study used baseline data of 34 267 participants aged 45-70 from the Consultants des centres d'examen de santé de la sécurité sociale (CONSTANCES) cohort...
October 2018: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/29800005/association-of-anticholinergic-drug-use-with-risk-for-late-age-related-macular-degeneration
#3
Gauthier Aldebert, Jean-Luc Faillie, Dominique Hillaire-Buys, Thibault Mura, Isabelle Carrière, Cécile Delcourt, Catherine Creuzot-Garcher, Max Villain, Vincent Daien
Importance: Amyloid-β is a major component of retinal drusen, the primary lesions of age-related macular degeneration (AMD), and autopsy and animal models suggested that anticholinergic drug (ACD) use increased brain amyloid-β deposition. Objective: To investigate the association between exposure to ACDs and late AMD (features of neovascular AMD or geographic atrophy of the retinal pigment epithelium in at least 1 eye). Design, Setting and Participants: A multicenter case-control study in 4 French ophthalmologic centers comprising 200 cases with late AMD and 200 controls enrolled from July 2016 to June 2017...
July 1, 2018: JAMA Ophthalmology
https://www.readbyqxmd.com/read/29736815/anticholinergic-drug-burden-tools-scales-and-adverse-outcomes-in-different-clinical-settings-a-systematic-review-of-reviews
#4
REVIEW
Tomas J Welsh, Veronika van der Wardt, Grace Ojo, Adam L Gordon, John R F Gladman
BACKGROUND: Cumulative anticholinergic exposure (anticholinergic burden) has been linked to a number of adverse outcomes. To conduct research in this area, an agreed approach to describing anticholinergic burden is needed. OBJECTIVE: This review set out to identify anticholinergic burden scales, to describe their rationale, the settings in which they have been used and the outcomes associated with them. METHODS: A search was performed using the Healthcare Databases Advanced Search of MEDLINE, EMBASE, Cochrane, CINAHL and PsycINFO from inception to October 2016 to identify systematic reviews describing anticholinergic burden scales or tools...
May 8, 2018: Drugs & Aging
https://www.readbyqxmd.com/read/29683887/association-of-anticholinergic-risk-score-with-functional-status-in-patients-preparing-for-pelvic-reconstructive-surgery
#5
Taylor J Brueseke, Maria de la Luz Nieto, Samantha Pulliam, Jennifer M Wu
OBJECTIVES: Anticholinergic medication use has been associated with cognitive impairment and other functional limitations, particularly in older patients. The anticholinergic risk score (ARS) can be used to measure a patient's cumulative exposure to medications with anticholinergic properties. Our primary objective was to evaluate the correlation between ARS and functional status, as measured by instrumental activities of daily living (IADL), in patients preparing to undergo urogynecologic surgery...
April 20, 2018: Female Pelvic Medicine & Reconstructive Surgery
https://www.readbyqxmd.com/read/28940566/anticholinergic-burden-and-dry-mouth-among-finnish-community-dwelling-older-adults
#6
Antti Tiisanoja, Anna-Maija Syrjälä, Kaija Komulainen, Pasi Lampela, Sirpa Hartikainen, Heidi Taipale, Matti Knuuttila, Pekka Ylöstalo
OBJECTIVE: The aim was to study whether the anticholinergic burden of drugs is related to xerostomia and salivary secretion among community-dwelling elderly people. BACKGROUND: Anticholinergic drugs have been shown to be a risk factor for dry mouth, but little is known about the effects of cumulative exposure to anticholinergic drugs measured by anticholinergic burden on salivary secretion or xerostomia. METHODS: The study population consisted of 152 community-dwelling, dentate, non-smoking, older people from the Oral Health GeMS study...
March 2018: Gerodontology
https://www.readbyqxmd.com/read/27919104/dual-health-care-system-use-and-high-risk-prescribing-in-patients-with-dementia-a-national-cohort-study
#7
Joshua M Thorpe, Carolyn T Thorpe, Walid F Gellad, Chester B Good, Joseph T Hanlon, Maria K Mor, John R Pleis, Loren J Schleiden, Courtney Harold Van Houtven
Background: Recent federal policy changes attempt to expand veterans' access to providers outside the Department of Veterans Affairs (VA). Receipt of prescription medications across unconnected systems of care may increase the risk for unsafe prescribing, particularly in persons with dementia. Objective: To investigate the association between dual health care system use and potentially unsafe medication (PUM) prescribing. Design: Retrospective cohort study...
February 7, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27663186/anticholinergic-drug-burden-in-noncancer-versus-cancer-patients-near-the-end-of-life
#8
COMPARATIVE STUDY
Michael J Hochman, Arif H Kamal, Steven P Wolf, Greg P Samsa, David C Currow, Amy P Abernethy, Thomas W LeBlanc
CONTEXT: Anticholinergic drugs can cause several side effects, impairing cognition and quality of life (QOL). Cancer patients are often exposed to increasing cumulative anticholinergic load (ACL) as they approach death, but this burden has not been examined in patients with nonmalignant diseases. OBJECTIVES: To determine ACL and its impact in noncancer versus cancer palliative care patients. METHODS: We performed a secondary analysis of 244 subjects enrolled in a randomized controlled trial...
November 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/27660331/association-of-anticholinergic-burden-with-adverse-effects-in-older-people-with-intellectual-disabilities-an-observational-cross-sectional-study
#9
Máire O'Dwyer, Ian D Maidment, Kathleen Bennett, Jure Peklar, Niamh Mulryan, Philip McCallion, Mary McCarron, Martin C Henman
BACKGROUND: No studies to date have investigated cumulative anticholinergic exposure and its effects in adults with intellectual disabilities. AIMS: To determine the cumulative exposure to anticholinergics and the factors associated with high exposure. METHOD: A modified Anticholinergic Cognitive Burden (ACB) scale score was calculated for a representative cohort of 736 people over 40 years old with intellectual disabilities, and associations with demographic and clinical factors assessed...
December 2016: British Journal of Psychiatry: the Journal of Mental Science
https://www.readbyqxmd.com/read/25621434/cumulative-use-of-strong-anticholinergics-and-incident-dementia-a-prospective-cohort-study
#10
Shelly L Gray, Melissa L Anderson, Sascha Dublin, Joseph T Hanlon, Rebecca Hubbard, Rod Walker, Onchee Yu, Paul K Crane, Eric B Larson
IMPORTANCE: Many medications have anticholinergic effects. In general, anticholinergic-induced cognitive impairment is considered reversible on discontinuation of anticholinergic therapy. However, a few studies suggest that anticholinergics may be associated with an increased risk for dementia. OBJECTIVE: To examine whether cumulative anticholinergic use is associated with a higher risk for incident dementia. DESIGN, SETTING, AND PARTICIPANTS: Prospective population-based cohort study using data from the Adult Changes in Thought study in Group Health, an integrated health care delivery system in Seattle, Washington...
March 2015: JAMA Internal Medicine
https://www.readbyqxmd.com/read/25246778/drug-burden-index-in-older-adults-theoretical-and-practical-issues
#11
REVIEW
Lisa Kouladjian, Danijela Gnjidic, Timothy F Chen, Arduino A Mangoni, Sarah N Hilmer
Anticholinergic and sedative medications are commonly used in older adults and are associated with adverse clinical outcomes. The Drug Burden Index was developed to measure the cumulative exposure to these medications in older adults and its impact on physical and cognitive function. This narrative review discusses the research and clinical applications of the Drug Burden Index, and its advantages and limitations, compared with other pharmacologically developed measures of high-risk prescribing.
2014: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/24723335/associations-of-drug-burden-index-with-falls-general-practitioner-visits-and-mortality-in-older-people
#12
Prasad S Nishtala, Sujita W Narayan, Ting Wang, Sarah N Hilmer
AIM: On a population level in people aged ≥65 years old living in New Zealand, the aim of this study is to quantify each individual's cumulative exposure to anticholinergic and sedative medicines using the Drug Burden Index (DBI) and examine the impact of DBI on fall-related hospitalisations, general practitioner (GP) visits, and all-cause mortality. METHOD: The study used data extracted from Pharmaceutical Claims Data Mart (2011), National Minimum Data set (2012), Births, Death and Marriages (2012) and GP Visits (2012) for patient demographics, hospitalisations and mortality...
July 2014: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/24454696/impact-of-high-risk-drug-use-on-hospitalization-and-mortality-in-older-people-with-and-without-alzheimer-s-disease-a-national-population-cohort-study
#13
Danijela Gnjidic, Sarah N Hilmer, Sirpa Hartikainen, Anna-Maija Tolppanen, Heidi Taipale, Marjaana Koponen, J Simon Bell
BACKGROUND: Evidence is lacking about outcomes associated with the cumulative use of anticholinergic and sedative drugs in people with Alzheimer's disease (AD). This retrospective cohort study investigated the relationship between cumulative exposure to anticholinergic and sedative drugs and hospitalization and mortality in people with and without AD in Finland. METHODS: Community-dwelling people aged 65 years and over, with AD on December 31(st) 2005 (n = 16,603) and individually matched (n = 16,603) comparison persons (age, sex, region of residence) were identified by the Social Insurance Institution of Finland...
2014: PloS One
https://www.readbyqxmd.com/read/24334709/temporal-trends-in-anticholinergic-medication-prescription-in-older-people-repeated-cross-sectional-analysis-of-population-prescribing-data
#14
COMPARATIVE STUDY
Deepa Sumukadas, Marion E T McMurdo, Arduino A Mangoni, Bruce Guthrie
BACKGROUND: in older people, medications with anticholinergic (antimuscarinic) effects are associated with adverse clinical outcomes, the risk increasing with increasing anticholinergic exposure. Many anticholinergics are recognised as potentially inappropriate and efforts to reduce prescription have been ongoing. We examined temporal trends of anticholinergic prescription and exposure in older people. METHODS: : anonymised data on all prescribed medication dispensed to people ≥65 years in Tayside, Scotland were obtained for the years 1995 (n = 67,608) and 2010 (n = 73,465)...
July 2014: Age and Ageing
https://www.readbyqxmd.com/read/23669567/pharmacokinetics-of-intravesical-versus-oral-oxybutynin-in-healthy-adults-results-of-an-open-label-randomized-prospective-clinical-study
#15
Petra Krause, Uwe Fuhr, Jörg Schnitker, Uwe Albrecht, Raimund Stein, Peter Rubenwolf
PURPOSE: We investigated the pharmacokinetics of intravesical oxybutynin and discuss the clinical implications of the results. MATERIALS AND METHODS: We performed an open label, randomized, 3-period crossover clinical study in 20 healthy adults. In periods 1 and 2 subjects received a single dose of 10 mg oxybutynin HCl solution intravesically or a 5 mg tablet orally. Period 3 comprised repeat intravesical applications (7 doses) of 10 mg oxybutynin HCl. Enantioselective concentrations of oxybutynin and N-desethyloxybutynin were quantified by liquid chromatography-mass spectrometry...
November 2013: Journal of Urology
https://www.readbyqxmd.com/read/23388494/high-risk-prescribing-in-older-adults-prevalence-clinical-and-economic-implications-and-potential-for-intervention-at-the-population-level
#16
Danijela Gnjidic, David G Le Couteur, Sallie-Anne Pearson, Andrew J McLachlan, Rosalie Viney, Sarah N Hilmer, Fiona M Blyth, Grace Joshy, Emily Banks
BACKGROUND: High risk prescribing can compromise independent wellbeing and quality of life in older adults. The aims of this project are to determine the prevalence, risk factors, clinical consequences, and costs of high risk prescribing, and to assess the impact of interventions on high risk prescribing in older people. METHODS: The proposed project will utilise data from the 45 and Up Study, a large scale cohort of 267,153 men and women aged 45 and over recruited during 2006-2009 from the state of New South Wales, Australia linked to a range of administrative health datasets...
2013: BMC Public Health
https://www.readbyqxmd.com/read/22530705/drug-burden-index-and-hospitalization-among-community-dwelling-older-people
#17
Eija Lönnroos, Danijela Gnjidic, Sarah N Hilmer, J Simon Bell, Hannu Kautiainen, Raimo Sulkava, Sirpa Hartikainen
BACKGROUND: Medications with anticholinergic and sedative effects carry significant risks in older people. Adverse events arising from the use of these medications may also lead to hospitalization and contribute to length of stay. The Drug Burden Index (DBI) is a tool that measures a person's total exposure to medications with anticholinergic and sedative properties, using the principles of dose response and maximal effect. Cumulative anticholinergic and sedative drug burden measured using the DBI has been associated with clinically important outcomes in older people...
May 1, 2012: Drugs & Aging
https://www.readbyqxmd.com/read/19363211/cardiovascular-events-associated-with-ipratropium-bromide-in-copd
#18
COMPARATIVE STUDY
Sarika S Ogale, Todd A Lee, David H Au, Denise M Boudreau, Sean D Sullivan
BACKGROUND: Studies have suggested an increased risk of cardiovascular morbidity and mortality associated with the use of ipratropium bromide. We sought to examine the association between ipratropium bromide use and the risk of cardiovascular events (CVEs). METHODS: We performed a cohort study of 82,717 US veterans with a new diagnosis of COPD between 1999 and 2002. Subjects were followed until they had their first hospitalization for a CVE (acute coronary syndrome, heart failure, or cardiac dysrhythmia), they died, or the end of the study period (September 30, 2004)...
January 2010: Chest
https://www.readbyqxmd.com/read/19346155/the-current-prevalence-and-factors-associated-with-tardive-dyskinesia-among-filipino-schizophrenic-patients
#19
Criscely L Go, Raymond L Rosales, Rico J Caraos, Hubert H Fernandez
OBJECTIVE: To determine the prevalence of and the factors associated with tardive dyskinesia (TD) among Filipino patients with schizophrenia admitted at the National Center for Mental Health. STUDY DESIGN: Cross-sectional study. METHODS: A total of 227 inpatients fulfilling the DSM-IV TR criteria for schizophrenia participated in the study. Demographic data including age, disease duration and medication intake were obtained. The Abnormal Involuntary Movement Scale (AIMS) and Simpson Angus Rating Scale (SARS) were performed on all patients...
November 2009: Parkinsonism & related Disorders
https://www.readbyqxmd.com/read/19093918/cumulative-anticholinergic-exposure-is-associated-with-poor-memory-and-executive-function-in-older-men
#20
Ling Han, Joseph V Agostini, Heather G Allore
OBJECTIVES: To examine the longitudinal relationship between cumulative exposure to anticholinergic medications and memory and executive function in older men. DESIGN: Prospective cohort study. SETTING: A Department of Veterans Affairs primary care clinic. PARTICIPANTS: Five hundred forty-four community-dwelling men aged 65 and older with diagnosed hypertension. MEASUREMENTS: The outcomes were measured using the Hopkins Verbal Recall Test (HVRT) for short-term memory and the instrumental activity of daily living (IADL) scale for executive function at baseline and during follow-up...
December 2008: Journal of the American Geriatrics Society
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