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Anticholinergic Drug Use, Serum Anticholinergic Activity, and Adverse Drug Events Among Older People: A Population-Based Study

Abstract

Background

The serum anticholinergic activity (SAA) assay has been used to quantify patients’ anticholinergic load. In addition, several ranked lists of anticholinergic drugs have been developed to assess anticholinergic drug burden.

Objective

This study investigated whether SAA assay results and scores from three ranked lists of anticholinergic drugs (Carnahan’s Anticholinergic Drug Scale, Rudolph’s Anticholinergic Risk Scale, and Chew’s list) are associated with anticholinergic adverse drug events (ADEs) in older people.

Methods

We analyzed data from participants in the population-based Geriatric Multidisciplinary Good Care of the Elderly Study in Kuopio, Finland (n = 621). Demographic, diagnostic, and drug use data were collected during standardized interviews and verified from medical records. Vision, functional capacity, cognition, and mood were assessed using validated techniques. The SAA was measured from blood samples.

Results

The SAA was not associated with anticholinergic ADEs. Anticholinergic drug burden computed using each of the three lists was inversely associated with short-distance vision (p < 0.01), activities of daily living (p < 0.05), and instrumental activities of daily living (p < 0.05) in persons with and without dementia. Furthermore, poorer Mini Mental State Examination and poorer Geriatric Depression Scale scores were associated with the anticholinergic drug burden in persons without dementia (p < 0.05–p < 0.001). The association between anticholinergic drug burden and ADEs was strongest when using the lists developed by Carnahan and Chew.

Conclusions

Scores obtained from ranked lists of anticholinergic drugs were associated with clinically significant anticholinergic ADEs but the SAA was not. This finding supports the usefulness of these lists to help identify patients at risk of anticholinergic ADEs in clinical practice.

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Acknowledgments

We thank Hannele Jaatinen and Pirjo Hänninen for technical help in SAA analysis. The authors declare that they have no conflict of interest. This study was supported by the Social Insurance Institution of Finland (data collection and analysis) and City of Kuopio (data collection). The authors have no conflicts of interest relevant to the results of this manuscript.

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Correspondence to Pasi Lampela.

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Lampela, P., Lavikainen, P., Garcia-Horsman, J.A. et al. Anticholinergic Drug Use, Serum Anticholinergic Activity, and Adverse Drug Events Among Older People: A Population-Based Study. Drugs Aging 30, 321–330 (2013). https://doi.org/10.1007/s40266-013-0063-2

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  • DOI: https://doi.org/10.1007/s40266-013-0063-2

Keywords

  • Mini Mental State Examination
  • Anticholinergic Drug
  • Mini Mental State Examination Score
  • Trospium
  • Tiotropium Bromide