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Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review

Citation

Salahudeen, MS and Duffull, SB and Nishtala, PS, Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review, BMC geriatrics, 15 pp. 1-14. ISSN 1471-2318 (2015) [Refereed Article]


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Copyright Statement

Copyright 2015 Salahudeen et al. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

DOI: doi:10.1186/s12877-015-0029-9

Abstract

Background: The cumulative effect of taking multiple medicines with anticholinergic properties termed as anticholinergic burden can adversely impact cognition, physical function and increase the risk of mortality. Expert opinion derived risk scales are routinely used in research and clinical practice to quantify anticholinergic burden. These scales rank the anticholinergic activity of medicines into four categories, ranging from no anticholinergic activity (= 0) to definite/high anticholinergic activity (= 3). The aim of this systematic review was to compare anticholinergic burden quantified by the anticholinergic risk scales and evaluate associations with adverse outcomes in older people.

Methods: We conducted a literature search in Ovid MEDLINE, EMBASE and PsycINFO from 1984-2014 to identify expert opinion derived anticholinergic risk scales. In addition to this, a citation analysis was performed in Web of Science and Google Scholar to track prospective citing of references of selected articles for assessment of individual scales for adverse anticholinergic outcomes. The primary outcomes of interest were functional and cognitive outcomes associated with anticholinergic burden in older people. The critical appraisals of the included studies were performed by two independent reviewers and the data were extracted onto standardised forms.

Results: The primary electronic literature search identified a total of 1250 records in the 3 different databases. On the basis of full-text analysis, we identified 7 expert-based anticholinergic rating scales that met the inclusion criteria. The rating of anticholinergic activity for medicines among these rating scales was inconsistent. For example, quetiapine was rated as having high anticholinergic activity in one scale (n = 1), moderate in another scale (n = 1) and low in two other scales (n = 2). Citation analysis of the individual scales showed that the Anticholinergic Cognitive Burden (ACB) scale was the most frequently validated expert based anticholinergic scale for adverse outcomes (N = 13).

Conclusions: In conclusion, there is not one standardised tool for measuring anticholinergic burden. Cohort studies have shown that higher anticholinergic burden is associated with negative brain effects, poorer cognitive and functional outcomes.

Item Details

Item Type:Refereed Article
Keywords:anticholinergic scales, antimuscarinic, adverse outcomes, older people, anticholinergic burden, expert opinion, rating scale
Research Division:Medical and Health Sciences
Research Group:Pharmacology and Pharmaceutical Sciences
Research Field:Clinical Pharmacy and Pharmacy Practice
Objective Division:Health
Objective Group:Health and Support Services
Objective Field:Health Policy Economic Outcomes
Author:Salahudeen, MS (Dr Mohammed Salahudeen)
ID Code:125376
Year Published:2015
Web of Science® Times Cited:49
Deposited By:Pharmacy
Deposited On:2018-04-15
Last Modified:2018-06-07
Downloads:4 View Download Statistics

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