Joined in 2023 
82 
63 About this deal
Carnahan RM, Lund BC, Perry PJ, ET AL. (2006) The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity . J Clin Pharmacol. doi: 10.1177/0091270006292126. The studies involving human participants were reviewed and approved by Ethik-Kommission der Medizinischen Fakultät der Universität Duisburg-Essen. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. Author Contributions The most commonly used drugs have not changed over time. Cannabis is the most prevalent, followed by powder cocaine, MDMA, ketamine and amphetamine.
Ancelin ML, Artero S, Portet F, et al (2006) Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ. doi: 10.1136/bmj.38740.439664.DE. There were no changes in last year drug use for the majority of individual drugs in the year ending June 2022 compared with the year ending March 2020, except for ecstasy and nitrous oxide; prevalence of ecstasy use fell from 1.4% to 0.7% in adults aged 16 to 59 years and from 4.0% to 1.1% in adults aged 16 to 24 years while prevalence of nitrous oxide use fell from 2.4% to 1.3% for adults aged 16 to 59 years and from 8.7% to 3.9% for adults aged 16 to 24 years. A number of studies have reported on the adverse effects associated with higher anticholinergic burden. Studies have found that anticholinergic medicines may adversely affect cognitive and physical function [ 4- 13] and anticholinergic burden is a strong predictor of cognitive and physical impairments in older people living in both community and residential care [ 4- 7, 12, 14]. A retrospective study conducted in Finland found that the use of medicines with anticholinergic properties is a strong independent predictor of mortality in older people [ 15, 16]. More recently, several studies in the older population have also reported an association between anticholinergic exposure and mortality with an increased risk of hospitalisations [ 1, 6, 17, 18].Yeh Y-C, Liu C-L, Peng L-N, Lin M-H, Chen L-K. Potential benefits of reducing medication-related anticholinergic burden for demented older adults: A prospective cohort study. Geriatr Gerontol Int. 2013;13(3):694–700.
Numerous studies have found an association between use of anticholinergic medicines and adverse outcomes related to physical function, cognition and falls in older people [ 2, 4, 29- 31]. Pasina et al. compared anticholinergic burden derived from both ACB and ARS scales and found strong associations with impairment in cognitive and functional outcomes [ 27]. A study conducted by Rudolph et al. validated higher ARS scores were associated with increased risk of both peripheral and central anticholinergic adverse effects in older people [ 19]. Furthermore, Campbell et al. and Fox et al. conducted studies using ACB scale and found that the use of definite anticholinergics increased the risk of cognitive impairment among older people [ 32, 33]. Overall, research has shown that use of medicines with anticholinergic activity among older people is associated with physical and cognitive decline [ 34, 35].The primary electronic literature search identified a total of 1250 articles from 3 different databases such as Ovid MEDLINE, EMBASE, and PsycINFO. EndNote was used to eliminate duplicates and we considered 932 articles for screening. Out of 932 screened articles based on title and abstract, only 21 were eligible for full-text analysis. From the eligible 21 studies, 14 were excluded on full text analysis according to the set inclusion and exclusion criteria. Hence, in total, 7 studies were included in this review that considered expert opinion/s in the development of the anticholinergic rating scales [ 9, 19, 22- 26]. Figure 1 depicts a flow-diagram of the identification, screening, eligibility and exclusion process. Drug use may not be independently related to lifestyle factors but instead affected by factors such as age, as younger people may be more likely to visit nightclubs or bars. Household and area characteristics Pasina L, Djade CD, Lucca U, Nobili A, Tettamanti M, Franchi C, et al. Association of anticholinergic burden with cognitive and functional status in a cohort of hospitalized elderly: comparison of the anticholinergic cognitive burden scale and anticholinergic risk scale: results from the REPOSI study. Drugs Aging. 2013;30(2):103–12.
The Anticholinergic Cognitive Burden Scale is derived from a comprehensive literature review of medications that possess anticholinergic activity. This scale categorizes drugs based on their potential negative impact on cognition, ranging from zero (no anticholinergic activity) to possible and finally to definite anticholinergic activity, with scores ranging from zero to three. The Anticholinergic Cognitive Burden Scale identifies 88 medicines with known anticholinergic activity. With increasing age comes age-related comorbidities that may be influenced by lifestyle, genomic makeup and other demographic factors. The increasing number of health issues require multiple medications (polypharmacy) to treat them. A 2005 study found that as of 2002, older adults defined as ≥ 65 years comprised 12% of the population of the United States but constituted 33% of its prescription drug expenditure (50 billion dollars) [ 1]. Whilst polypharmacy may be beneficial in treating underlying health conditions in older adults, it increases the risk of adverse drug events. In particular, taking multiple drugs with anticholinergic effects increases the risk of anticholinergic burden (AB) in older adults because of age-related pharmacokinetic and pharmacodynamic changes [ 2].
Two reviewers (M.S.S. and P.S.N.) extracted data onto standardised format based on study population, study design, use of appropriate rating scales to quantify anticholinergic burden and outcome measures. The primary outcomes of interest were functional and cognitive outcomes associated with anticholinergic burden quantified by the expert opinion derived anticholinergic rating scales. The Anticholinergic Drug Scale (ADS) developed by Carnahan et al. [ 9] based on expert consensus ranks medicines with anticholinergic properties in an ordinal fashion from 0 to 3, with 0 indicating no known anticholinergic activity and 3 indicating definite/high anticholinergic activity. This scale was initially referred to as the Clinician-rated Anticholinergic Scale (CrAS) modified version. An expert panel of geriatric psychiatrists identified and reviewed 340 medicines with known anticholinergic activity and assigned a score from 0 to 3 according to their clinical experience and the pharmacologic mechanism of each medicine. The ADS scale contains 117 medicines with known anticholinergic activity. The ADS scale has shown to be of utility in various clinical settings such as community, nursing homes, outpatient clinics, and hospitals. The adverse outcomes studied in these settings were mainly, cognitive, functional, risk of hospitalisation, and mortality. It is important to note that personal characteristics are not necessarily independently related to drug use. For example, the relationship between drug use and marital status may be related to age. Lifestyle characteristics Selecting the title and abstract of the publication, studies retrieved were screened by two independent reviewers for its eligibility for inclusion in the review process (M.S.S. and P.S.N.). The eligible studies were subject to a thorough full text analysis for relevance and pre-defined inclusion criteria. Studies that met the following criteria were included in the final review. Drag LL, Wright SL, Bieliauskas LA. Prescribing practices of anticholinergic medications and their association with cognition in an extended care setting. J Appl Gerontol. 2012;31(2):239–59.
Great Deal 
New Comment