Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Feb 10;12(2):e0171353.
doi: 10.1371/journal.pone.0171353. eCollection 2017.

Anticholinergic burden and cognitive function in a large German cohort of hospitalized geriatric patients

Barbara Pfistermeister  1 , Thomas Tümena  2 , Karl-Günter Gaßmann  2   3 , Renke Maas  1 , Martin F Fromm  1
Affiliations

Anticholinergic burden and cognitive function in a large German cohort of hospitalized geriatric patients

Barbara Pfistermeister et al. PLoS One. .

Abstract

Purpose: Previous studies suggest an association between use of anticholinergic drugs in elderly patients and cognitive impairment. However, there are still limited data on the association of anticholinergic drug use and cognitive impairment as well as contribution of individual drugs to anticholinergic load using large, well-documented patient cohorts treated in geriatric units from Europe.

Methods: We investigated 797,440 prescriptions to 89,579 hospitalized patients treated in geriatric units within the GiB-DAT database. Data of all patients discharged between 1 January 2013 and 30 June 2015 was included. The Anticholinergic Cognitive Burden (ACB) scale was used to classify anticholinergic drugs as definite (score 2 or 3) and possible anticholinergics (score 1). Cognitive function was determined using Mini-Mental State Examination (MMSE) and the standardized scale for dementia (4D+S).

Results: In two multivariable logistic regression models age, sex, number of drugs and ACB total scores were identified as variables independently associated with cognitive impairment as measured by MMSE (odds ratio per ACB unit 1.114, 95% CI 1.099-1.130) or the diagnosis dementia (odds ratio 1.159 per ACB unit, 95% CI 1.144-1.173, both p < 0.0001). High anticholinergic load was associated with patients with severe cognitive impairment (p < 0.05 for all pairwise comparisons). ACB score 3 anticholinergic drugs contributed 77.9% to the cumulative amount of ACB points in patients with an anticholinergic load of 3 and higher.

Conclusions: Using a cross-sectional study design, a significant positive association between anticholinergic drug load and cognitive impairment in European patients treated in specialised geriatric units was found. The most frequently used definitve anticholinergic drugs were quetiapine, amitriptyline and carbamazepine.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: BP declared no conflict of interest. TT declared no conflict of interest. KGG reported receiving payments for lectures from Pfizer and Bristol-Myers Squibb. RM declared no conflict of interest. MFF reported receiving personal compensation from Boehringer Ingelheim Pharma for expert testimony and payments for lectures from Bayer-Schering Pharma, Boehringer Ingelheim Pharma, Janssen Cilag, Sanofi-Aventis Deutschland, and Merck. The Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, received compensation from Merck and Sanofi-Aventis Deutschland for commissioned research by MFF's group and from Gilead for supplies for in vitro studies. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Contribution of drugs with an ACB score of 1, 2 or 3 to the cumulative ACB score of the entire study population.
54,211 anticholinergics were used with a cumulative ACB score of 76,934. X-axis groups of patients having individual ACB scores of 1, 2, 3, 4, 5, 6 or ≥ 7. Y-axis Cumulative ACB scores achieved in each group of patients and overview of ACB scoring points originating from drugs with ACB scores of 1,2 or 3, respectively.
Fig 2
Fig 2. Most commonly used definite anticholinergic drugs (i.e. ACB score 2 or 3) among the total study population.
Left y-axis Absolute number of drugs with definite anticholinergic properties received by patients. Right y-axis Proportion of the respective drug of all definite anticholinergics according to the ACB scale.
Fig 3
Fig 3. Cognitive impairment measured by the Mini-Mental State Examination (MMSE) and mean anticholinergic cognitive burden in patients of the GiB-DAT database.
A MMSE score of 0–17 indicates severe, 18–24 moderate and 25–30 no cognitive impairment. Error bar 95% confidence interval, *** p < 0.001 for overall and all pairwise comparisons.
Fig 4
Fig 4. Cognitive impairment measured by the item dementia of the 4D+S scale and mean anticholinergic cognitive burden in patients of the GiB-DAT database.
Error bar 95% confidence interval, *** p < 0.0001 for overall and pairwise comparisons except for the difference between moderate and severe dementia was borderline significance (p = 0.043).
See this image and copyright information in PMC

References

    1. Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly people. J R Soc Med. 2000;93(9):457–62. - PMC - PubMed
    1. Tune LE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry. 2001;62 Suppl 21:11–4. - PubMed
    1. Campbell N, Boustani M, Limbil T, Ott C, Fox C, Maidment I, et al. The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging. 2009;4:225–33. - PMC - PubMed
    1. Block CK, Logue E, Thaler NS, Scarisbrick DM, Mahoney JJ 3rd, Scott J, et al. The interaction between medical burden and anticholinergic cognitive burden on neuropsychological function in a geriatric primary care sample. Arch Clin Neuropsychol. 2015;30(2):105–13. 10.1093/arclin/acu073 - DOI - PubMed
    1. American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31. 10.1111/j.1532-5415.2012.03923.x - DOI - PMC - PubMed

Substances