Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study
Abstract Background Anticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise t...
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-022-03235-9 |
| _version_ | 1828161353119956992 |
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| author | Annabelle Hook Jessica L. Randall Carla M. Grubb Natalie Ellis Jack Wellington Aayushi Hemmad Agisilaos Zerdelis Andrew R. D. Winnett Benjamin D. W. Geers Bethany Sykes Charlotte N. Auty Cecilia Vinchenzo Christiane E. Thorburn Daniella Asogbon Emily Granger Heather Boagey Juliet Raphael Kajal Patel Kartik Bhargava Mary-Kate M. Dolley Matthew J. Maden Mehdin M. Shah Qao M. Lee Ratnaraj Vaidya Simran Sehdev Sneha Barai Sophie Roche Uzair Khalid David A. Codling Judith R. Harrison |
| author_facet | Annabelle Hook Jessica L. Randall Carla M. Grubb Natalie Ellis Jack Wellington Aayushi Hemmad Agisilaos Zerdelis Andrew R. D. Winnett Benjamin D. W. Geers Bethany Sykes Charlotte N. Auty Cecilia Vinchenzo Christiane E. Thorburn Daniella Asogbon Emily Granger Heather Boagey Juliet Raphael Kajal Patel Kartik Bhargava Mary-Kate M. Dolley Matthew J. Maden Mehdin M. Shah Qao M. Lee Ratnaraj Vaidya Simran Sehdev Sneha Barai Sophie Roche Uzair Khalid David A. Codling Judith R. Harrison |
| author_sort | Annabelle Hook |
| collection | DOAJ |
| description | Abstract Background Anticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission. Methods We included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient’s medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon’s rank test was used to look at the correlation between two subgroups upon admission and discharge. Results On admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant (p = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications. Conclusions Our cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission. |
| first_indexed | 2024-04-12T00:37:18Z |
| format | Article |
| id | doaj.art-4dcef91aea0d47ee960737ac97614e70 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-04-12T00:37:18Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-4dcef91aea0d47ee960737ac97614e702022-12-22T03:55:08ZengBMCBMC Geriatrics1471-23182022-10-0122111110.1186/s12877-022-03235-9Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional studyAnnabelle Hook0Jessica L. Randall1Carla M. Grubb2Natalie Ellis3Jack Wellington4Aayushi Hemmad5Agisilaos Zerdelis6Andrew R. D. Winnett7Benjamin D. W. Geers8Bethany Sykes9Charlotte N. Auty10Cecilia Vinchenzo11Christiane E. Thorburn12Daniella Asogbon13Emily Granger14Heather Boagey15Juliet Raphael16Kajal Patel17Kartik Bhargava18Mary-Kate M. Dolley19Matthew J. Maden20Mehdin M. Shah21Qao M. Lee22Ratnaraj Vaidya23Simran Sehdev24Sneha Barai25Sophie Roche26Uzair Khalid27David A. Codling28Judith R. Harrison29Cardiff University School of MedicineCardiff University School of MedicineCardiff University School of MedicineCardiff University School of MedicineCardiff University School of MedicineThe Medical School, Newcastle UniversityThe James Cook University HospitalWhipps Cross University HospitalSchool of Medicine, University of ManchesterUniversity of Exeter Medical SchoolSchool of Medicine, University of ManchesterLancaster Medical School, Faculty of Health and Medicine, Lancaster UniversityBristol Medical School, University of BristolBirmingham Medical School, College of Medical and Dental Sciences, University of BirminghamUniversity Hospitals of Morecambe Bay NHS Foundation TrustMedical Sciences Division, University of Oxford, John Radcliffe HospitalNorwich Medical School, University of East AngliaSchool of Medicine, University of ManchesterThe Medical School, Newcastle UniversityPeninsula Medical School, The Faculty of Medicine and DentistrySchool of Medicine, University of ManchesterBart’s and The London School of Medicine and Dentistry, Queen Mary’s University of LondonBart’s and The London School of Medicine and Dentistry, Queen Mary’s University of LondonThe Medical School, Newcastle UniversityFaculty of Medicine, University of SouthamptonSchool of Clinical Medicine, University of CambridgeMedical Sciences Division, University of Oxford, John Radcliffe HospitalUniversity College London Medical SchoolKing’s College London, Institute of Psychiatry, Psychology and NeuroscienceBiomedical Research Building Campus for Ageing and Vitality, Newcastle UniversityAbstract Background Anticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission. Methods We included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient’s medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon’s rank test was used to look at the correlation between two subgroups upon admission and discharge. Results On admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant (p = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications. Conclusions Our cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission.https://doi.org/10.1186/s12877-022-03235-9DementiaAlzheimer diseaseCholinesterase inhibitorsMuscarinic antagonistsAntidepressive agentsAntipsychotic agents |
| spellingShingle | Annabelle Hook Jessica L. Randall Carla M. Grubb Natalie Ellis Jack Wellington Aayushi Hemmad Agisilaos Zerdelis Andrew R. D. Winnett Benjamin D. W. Geers Bethany Sykes Charlotte N. Auty Cecilia Vinchenzo Christiane E. Thorburn Daniella Asogbon Emily Granger Heather Boagey Juliet Raphael Kajal Patel Kartik Bhargava Mary-Kate M. Dolley Matthew J. Maden Mehdin M. Shah Qao M. Lee Ratnaraj Vaidya Simran Sehdev Sneha Barai Sophie Roche Uzair Khalid David A. Codling Judith R. Harrison Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study BMC Geriatrics Dementia Alzheimer disease Cholinesterase inhibitors Muscarinic antagonists Antidepressive agents Antipsychotic agents |
| title | Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study |
| title_full | Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study |
| title_fullStr | Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study |
| title_full_unstemmed | Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study |
| title_short | Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study |
| title_sort | anti cholinergic drug burden in patients with dementia increases after hospital admission a multicentre cross sectional study |
| topic | Dementia Alzheimer disease Cholinesterase inhibitors Muscarinic antagonists Antidepressive agents Antipsychotic agents |
| url | https://doi.org/10.1186/s12877-022-03235-9 |
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