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Association of Anticholinergic Drug Burden with Cognitive and Functional Decline Over Time in Older Inpatients: Results from the CRIME Project

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Abstract

Background

Medications with anticholinergic properties, although widely used, may negatively affect cognitive and functional status in older patients. To date there is still no standardized method to quantify anticholinergic exposure. We analyzed the relationship of two different tools for the evaluation of the anticholinergic drug burden with cognitive and functional impairment in a sample of older hospitalized patients.

Methods

A retrospective and longitudinal analysis with 1-year follow-up of 1123 older hospitalized patients enrolled in seven Italian acute care wards was conducted. We assessed anticholinergic burden with the Anticholinergic Cognitive Burden (ACB) and Anticholinergic Risk Scale (ARS). Cognitive and functional status were evaluated at hospital discharge and during follow-up (3, 6, 12 months) using the Mini Mental State Examination (MMSE) and five basic activities of daily living (ADLs). Associations between anticholinergic burden and cognitive decline and incident disability were estimated using linear regression models for repeated measures and logistic models, respectively.

Results

The mean age of the study population was 81 ± 7.5 years. ACB and ARS classifications showed low correlation (Spearman’s rho = 0.39–0.43). Anticholinergic burden increased during hospitalization and was associated with cognitive and functional status. Patients with an ARS of ≥ 1 at discharge had  significantly lower baseline MMSE scores (ARS = 0: 23.1; ARS ≥ 1: 20.8; p = 0.002) and during follow-up presented a  significantly steeper MMSE score decline (− 0.15/month). Moreover, patients with an ACB of ≥ 1 at discharge had an almost threefold increased risk of developing disability (odds ratio 2.77, 95% confidence interval 1.39–5.54).

Conclusions

ACB and ARS have only a moderate degree of correlation. Use of drugs with anticholinergic properties in elderly patients is independently associated with cognitive and functional decline.

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Authors and Affiliations

  1. Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Via Aldo Moro no 8, 44124, Ferrara, Italy

    Gloria Brombo, Lara Bianchi, Elisa Maietti, Francesca Malacarne & Stefano Volpato

  2. Unit of Geriatric Pharmacoepidemiology, Italian National Research Center on Aging (INRCA), Contrada Muoio Piccolo, Cosenza, Italy

    Andrea Corsonello

  3. Geriatrics and Geriatrics Emergency Care, Italian National Research Center on Aging (INRCA), Via della Montagnola 81, Ancona, Italy

    Antonio Cherubini

  4. Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Piazzale Gambuli 1, Perugia, Italy

    Carmelinda Ruggiero

  5. Department of Gerontology, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Gemelli University Hospital, Largo Francesco Vito 1, Rome, Italy

    Graziano Onder

Authors
  1. Gloria Brombo
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  2. Lara Bianchi
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  3. Elisa Maietti
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  8. Graziano Onder
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  9. Stefano Volpato
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Corresponding author

Correspondence to Gloria Brombo.

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Funding

This work was supported by the Italian Ministry of Labour, Health and Social Policy (Bando Giovani Ricercatori 2007, Convenzione No. 4).

Conflict of interest

Gloria Brombo, Lara Bianchi, Elisa Maietti, Francesca Malacarne, Andrea Corsonello, Antonio Cherubini, Carmelinda Ruggiero, Graziano Onder and Stefano Volpato declare that they have no conflicts of interest relevant to the content of this review.

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Supplementary material 1 (DOC 113 kb)

40266_2018_584_MOESM2_ESM.tif

Electronic Supplementary Material Figure S1. Graphical representation of when the variables were evaluated. (TIFF 69 kb)

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Brombo, G., Bianchi, L., Maietti, E. et al. Association of Anticholinergic Drug Burden with Cognitive and Functional Decline Over Time in Older Inpatients: Results from the CRIME Project. Drugs Aging 35, 917–924 (2018). https://doi.org/10.1007/s40266-018-0584-9

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  • DOI: https://doi.org/10.1007/s40266-018-0584-9

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