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Impact of Multiple Low-Level Anticholinergic Medications on Anticholinergic Load of Community-Dwelling Elderly With and Without Dementia

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Abstract

Background

Elderly people, particularly those with dementia, are sensitive to adverse anticholinergic drug effects. This study examines the prevalence of anticholinergic medication, and anticholinergic load and its predictors, in community-dwelling elderly patients (aged 75 years and older) in Australia.

Methods

A research nurse visited the home of each participant (n = 1,044), compiled a list of current medications, and assessed participants’ cognitive status using a subsection of the revised Cambridge Examination for Mental Disorders of the Elderly (CAMCOG-R). Anticholinergic load was determined for each patient using the Anticholinergic Drug Scale (ADS).

Results

Multivariate analysis identified several patient factors that were associated with higher anticholinergic burden, including polypharmacy (i.e. taking five or more medications) (p < 0.001), increasing age (p = 0.018), CAMCOG-R dementia (p = 0.003), depression (p = 0.003), and lower physical quality of life (p < 0.001). The dementia group (n = 86) took a significantly higher number of medications (4.6 vs. 3.9; p = 0.04), and had a significantly higher anticholinergic load (1.5 vs. 0.8; p = 0.002) than those without dementia (n = 958). Approximately 60 % of the dementia group and 40 % of the non-dementia group were receiving at least one anticholinergic drug. This difference was due to the higher proportion of dementia patients taking level 1 (potentially anticholinergic) (p = 0.002) and level 3 (markedly anticholinergic) (p = 0.005) drugs.

Conclusions

There is considerable scope for the improvement of prescribing practices in the elderly, and particularly those with dementia. Importantly, level 1 anticholinergics have been identified as major contributors to the anticholinergic load in people with dementia. Longitudinal studies are required to determine the effects of increased and decreased anticholinergic load on cognitive function and other clinical outcomes for people with dementia.

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Acknowledgments

The authors thank the project officers and research nurses involved in this project for their skilled assistance, and the patient and GP participants for their involvement. This study was supported by the Australian Government’s National Health and Medical Research Council (grant ID#351220).

Dimity Pond has received financial support for speaking from Alzheimer’s Australia, and has served on advisory boards for Pfizer, Eli Lilly, and Nutricia within the past 3 years. Henry Brodaty has been a consultant, advisory board member, and/or sponsored speaker for Eli Lilly, Merck, Baxter, Sanofi, Servier, and Tau Therapeutics. Karen Mate, Karen Kerr, Evan Williams, John Marley, Peter Disler, and Parker Magin have no conflict of interest to report.

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Authors and Affiliations

  1. School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, 2308, Australia

    Karen E. Mate, Karen P. Kerr & Evan J. Williams

  2. School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia

    Dimity Pond & Parker J. Magin

  3. Faculty of Health, University of Queensland, Brisbane, QLD, Australia

    John Marley

  4. School of Rural Health, Monash University, Bendigo, VIC, Australia

    Peter Disler

  5. Dementia Collaborative Research Centre, Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia

    Henry Brodaty

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  1. Karen E. Mate
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Correspondence to Karen E. Mate.

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Mate, K.E., Kerr, K.P., Pond, D. et al. Impact of Multiple Low-Level Anticholinergic Medications on Anticholinergic Load of Community-Dwelling Elderly With and Without Dementia. Drugs Aging 32, 159–167 (2015). https://doi.org/10.1007/s40266-014-0230-0

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