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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

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Abstract

Background

Drugs with anticholinergic effects are associated with adverse events such as delirium and falls as well as cognitive decline and loss of independence.

Objective

The aim of the study was to evaluate the association between anticholinergic burden and both cognitive and functional status, according to the hypothesis that the cumulative anticholinergic burden, as measured by the Anticholinergic Cognitive Burden (ACB) Scale and Anticholinergic Risk Scale (ARS), increases the risk of cognitive decline and impairs activities of daily living.

Methods

This cross-sectional, prospective study (3-month telephone follow-up) was conducted in 66 Italian internal medicine and geriatric wards participating in the Registry of Polytherapies SIMI (Società Italiana di Medicina Interna) (REPOSI) study during 2010. The sample included 1,380 inpatients aged 65 years or older. Cognitive status was rated with the Short Blessed Test (SBT) and physical function with the Barthel Index. Each patient’s anticholinergic burden was evaluated using the ACB and ARS scores.

Results

The mean SBT score for patients treated with anticholinergic drugs was higher than that for patients receiving no anticholinergic medications as also indicated by the ACB scale, even after adjustment for age, sex, education, stroke and transient ischaemic attack [9.2 (95 % CI 8.6–9.9) vs. 8.5 (95 % CI 7.8–9.2); p = 0.05]. There was a dose–response relationship between total ACB score and cognitive impairment. Patients identified by the ARS had more severe cognitive and physical impairment than patients identified by the ACB scale, and the dose–response relationship between this score and ability to perform activities of daily living was clear. No correlation was found with length of hospital stay.

Conclusions

Drugs with anticholinergic properties identified by the ACB scale and ARS are associated with worse cognitive and functional performance in elderly patients. The ACB scale might permit a rapid identification of drugs potentially associated with cognitive impairment in a dose–response pattern, but the ARS is better at rating activities of daily living.

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Acknowledgments

The REPOSI study is a network of Italian internal medicine hospital wards that, voluntarily and without any financial support, agreed to participate in data collection during the 4 index weeks. All authors had full access to all data and take responsibility for its integrity and the accuracy of the data analysis. All authors reviewed the manuscript and contributed to the interpretation of results. The authors have no conflict of interest. We are grateful to Judith Baggott for editorial assistance.

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Authors and Affiliations

  1. Laboratory for Quality Assessment of Geriatric Therapies and Services, Drug Information Service for the Elderly, Mario Negri Institute for Pharmacological Research, Via Giuseppe La Masa, 19, 20156, Milan, Italy

    Luca Pasina

  2. Mario Negri Institute for Pharmacological Research, Milan, Italy

    Codjo D. Djade, Ugo Lucca, Alessandro Nobili, Mauro Tettamanti & Carlotta Franchi

  3. Internal Medicine I, Policlinico IRCCS San Donato, University of Milan, Milan, Italy

    Francesco Salerno

  4. Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy

    Salvatore Corrao

  5. Geriatric Unit, Spedali Civili, Department of Medical and Surgery Sciences, University of Brescia, Brescia, Italy

    Alessandra Marengoni

  6. Department of Internal Medicine, University of Perugia, Perugia, Italy

    Alfonso Iorio & Maura Marcucci

  7. Internal Medicine, Policlinico Umberto I, University “La Sapienza”, Rome, Italy

    Francesco Violi

  8. IRCCS Maggiore Hospital Foundation, Milan, Italy

    Pier Mannuccio Mannucci

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  1. Luca Pasina
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  2. Codjo D. Djade
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  4. Alessandro Nobili
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  7. Francesco Salerno
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  8. Salvatore Corrao
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  9. Alessandra Marengoni
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  10. Alfonso Iorio
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  11. Maura Marcucci
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  12. Francesco Violi
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  13. Pier Mannuccio Mannucci
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Corresponding author

Correspondence to Luca Pasina.

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On behalf of REPOSI Investigators.

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Pasina, L., Djade, C.D., Lucca, U. 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. Drugs Aging 30, 103–112 (2013). https://doi.org/10.1007/s40266-012-0044-x

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