Anticholinergic Medication Burden in Parkinson's Disease Outpatients.
Parkinson’s disease
Parkinson’s disease dementia
anticholinergic medications
cholinesterase inhibitors
Journal
Journal of Parkinson's disease
ISSN: 1877-718X
Titre abrégé: J Parkinsons Dis
Pays: Netherlands
ID NLM: 101567362
Informations de publication
Date de publication:
2022
2022
Historique:
pubmed:
23
11
2021
medline:
28
4
2022
entrez:
22
11
2021
Statut:
ppublish
Résumé
Individuals with Parkinson's disease (PD) may be especially vulnerable to future cognitive decline from anticholinergic medications. To characterize anticholinergic medication burden, determine the co-occurrence of anticholinergic and cholinesterase inhibitors, and to assess the correlations among anticholinergic burden scales in PD outpatients. We studied 670 PD outpatients enrolled in a clinic registry between 2012 and 2020. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Drug Burden Index-Anticholinergic component (DBI-Ach). Correlations between scales were assessed with weighted kappa coefficients. Between 31.5 to 46.3% of PD patients were taking medications with anticholinergic properties. Among the scales applied, the ACB produced the highest prevalence of medications with anticholinergic properties (46.3%). Considering only medications with definite anticholinergic activity (scores of 2 or 3 on ACB, ADS, or ARS), the most common anticholinergic drug classes were antiparkinsonian (8.2%), antipsychotic (6.4%), and urological (3.3%) medications. Cholinesterase inhibitors and medications with anticholinergic properties were co-prescribed to 5.4% of the total cohort. The most highly correlated scales were ACB and ADS (κ= 0.71), ACB and ARS (κ= 0.67), and ADS and ARS (κ= 0.55). A high proportion of PD patients (20%) were either taking antiparkinsonian, urological, or antipsychotic anticholinergic medications or were co-prescribed anticholinergic medications and cholinesterase inhibitors. By virtue of its detection of a high prevalence of anticholinergic medication usage and its high correlation with other scales, our data support use of the ACB scale to assess anticholinergic burden in PD patients.
Sections du résumé
BACKGROUND
Individuals with Parkinson's disease (PD) may be especially vulnerable to future cognitive decline from anticholinergic medications.
OBJECTIVE
To characterize anticholinergic medication burden, determine the co-occurrence of anticholinergic and cholinesterase inhibitors, and to assess the correlations among anticholinergic burden scales in PD outpatients.
METHODS
We studied 670 PD outpatients enrolled in a clinic registry between 2012 and 2020. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Drug Burden Index-Anticholinergic component (DBI-Ach). Correlations between scales were assessed with weighted kappa coefficients.
RESULTS
Between 31.5 to 46.3% of PD patients were taking medications with anticholinergic properties. Among the scales applied, the ACB produced the highest prevalence of medications with anticholinergic properties (46.3%). Considering only medications with definite anticholinergic activity (scores of 2 or 3 on ACB, ADS, or ARS), the most common anticholinergic drug classes were antiparkinsonian (8.2%), antipsychotic (6.4%), and urological (3.3%) medications. Cholinesterase inhibitors and medications with anticholinergic properties were co-prescribed to 5.4% of the total cohort. The most highly correlated scales were ACB and ADS (κ= 0.71), ACB and ARS (κ= 0.67), and ADS and ARS (κ= 0.55).
CONCLUSION
A high proportion of PD patients (20%) were either taking antiparkinsonian, urological, or antipsychotic anticholinergic medications or were co-prescribed anticholinergic medications and cholinesterase inhibitors. By virtue of its detection of a high prevalence of anticholinergic medication usage and its high correlation with other scales, our data support use of the ACB scale to assess anticholinergic burden in PD patients.
Identifiants
pubmed: 34806617
pii: JPD212769
doi: 10.3233/JPD-212769
pmc: PMC9602053
mid: NIHMS1842185
doi:
Substances chimiques
Antipsychotic Agents
0
Cholinergic Antagonists
0
Cholinesterase Inhibitors
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
599-606Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR002649
Pays : United States
Références
Mov Disord Clin Pract. 2020 Aug 29;7(7):803-809
pubmed: 33043076
Ann Neurol. 1987 Jul;22(1):26-30
pubmed: 3631918
Int J Clin Pharm. 2020 Apr;42(2):453-461
pubmed: 32281075
Eur Arch Psychiatry Clin Neurosci. 2010 Nov;260 Suppl 2:S111-5
pubmed: 20960005
Ann Neurol. 1983 Mar;13(3):243-8
pubmed: 6847136
Br J Clin Pharmacol. 2015 Nov;80(5):1169-75
pubmed: 25923961
JAMA Neurol. 2019 Jan 1;76(1):41-49
pubmed: 30285047
Arch Gerontol Geriatr. 2020 Mar - Apr;87:103885
pubmed: 31155228
Arch Intern Med. 2009 Jul 27;169(14):1317-24
pubmed: 19636034
J Am Geriatr Soc. 2015 Oct;63(10):2120-4
pubmed: 26480974
Am J Med. 2009 Dec;122(12):1142-1149.e1-2
pubmed: 19958893
Pharmacotherapy. 2019 Aug;39(8):798-808
pubmed: 31251824
Parkinsonism Relat Disord. 2019 Aug;65:224-229
pubmed: 31255536
J Clin Pharmacol. 2006 Dec;46(12):1481-6
pubmed: 17101747
J Neurol. 1996 Jul;243(7):543-6
pubmed: 8836945
JAMA Intern Med. 2015 Mar;175(3):401-7
pubmed: 25621434
Arch Intern Med. 2008 Mar 10;168(5):508-13
pubmed: 18332297
Ann Clin Transl Neurol. 2020 Apr;7(4):449-461
pubmed: 32285645
J Parkinsons Dis. 2015;5(4):743-7
pubmed: 26444094
J Clin Pharmacol. 2011 Feb;51(2):256-63
pubmed: 20489026
J Neurol Neurosurg Psychiatry. 2010 Feb;81(2):160-5
pubmed: 19770163
JAMA Intern Med. 2019 Aug 01;179(8):1084-1093
pubmed: 31233095
J Neurol Neurosurg Psychiatry. 1985 May;48(5):413-21
pubmed: 3998751
J Am Geriatr Soc. 2015 Jan;63(1):85-90
pubmed: 25597560
Arch Intern Med. 2007 Apr 23;167(8):781-7
pubmed: 17452540
J Gerontol A Biol Sci Med Sci. 2020 Apr 17;75(5):995-1002
pubmed: 30590397
PLoS One. 2016 Mar 03;11(3):e0150621
pubmed: 26939130
Eur J Clin Pharmacol. 2015 Oct;71(10):1271-7
pubmed: 26254777
PLoS One. 2020 Feb 24;15(2):e0228532
pubmed: 32092055
Drugs Aging. 2019 Mar;36(3):289-297
pubmed: 30652263
Acta Neuropathol. 1984;64(1):43-52
pubmed: 6089493
Ann Fam Med. 2017 Nov;15(6):561-569
pubmed: 29133497
Eur J Clin Pharmacol. 2015 Aug;71(8):1011-9
pubmed: 26081062
Neurology. 2010 Jul 13;75(2):152-9
pubmed: 20625168
Psychogeriatrics. 2013 Mar;13(1):17-24
pubmed: 23551407
BMJ. 2018 Apr 25;361:k1315
pubmed: 29695481
Alzheimers Dement (N Y). 2017 Jul 19;3(3):471-479
pubmed: 29067353
Mov Disord. 2016 May;31(5):632-6
pubmed: 27028036