Risk of hospitalization associated with anticholinergic medication for patients with dementia

• Published in: Psychogeriatrics Vol. 18; no. 1; pp. 57 - 63
• Main Authors: Watanabe, Shuichi, Fukatsu, Takahide, Kanemoto, Kosuke
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.01.2018; Blackwell Publishing Ltd
• Subjects: Activities of daily living; adverse effect; Aged; Aged, 80 and over; Alzheimer's disease; Anticholinergics; antidepressants; antipsychotics; Brain - diagnostic imaging; Cholinergic Antagonists - administration & dosage; Cholinergic Antagonists - adverse effects; Cholinergic Antagonists - therapeutic use; Cognitive ability; Confidence intervals; Delirium - drug therapy; Dementia; Dementia - chemically induced; Dementia - drug therapy; Dementia - epidemiology; Dementia disorders; Female; Geriatrics; Hospitalization; Hospitalization - statistics & numerical data; Humans; Lewy bodies; Magnetic Resonance Imaging; Male; Neurodegenerative diseases; Psychopharmacology; Psychotropic drugs; Retrospective Studies; Risk Factors; antipsychotics; dementia; risk factors; antidepressants; adverse effect
• ISSN: 1346-3500; 1479-8301
• DOI: 10.1111/psyg.12291

Background With the ageing of the general population, demand has grown for measures to prevent hospitalization for dementia, which can exacerbate problems associated with activities of daily living in elderly individuals. Anticholinergic medication has been shown to cause falls, delirium, and cognitive impairment in aged patients. However, the risk of hospitalization associated with the administration of anticholinergics is unclear. Methods We analyzed the records of 61 outpatients (26 men, 35 women; mean age: 78 ± 7 years; mean follow‐up period: 420 days) diagnosed with dementia (Alzheimer’s disease: n = 45; dementia with Lewy bodies: n = 3; undifferentiated n = 13) and prescribed anti‐dementia drugs between May 2013 and December 2014. Medication history was noted, and the patients were divided into two groups according to the Anticholinergic Risk Scale: with risk (n = 13) and without risk (n = 48). Outcome was judged based on an end‐point of hospitalization or death. Kaplan–Meier survival and Cox proportional hazard analyses were performed. Results Eight patients with anticholinergic risk and 12 without anticholinergic risk reached the end‐point (P < 0.005). Analysis with a proportional hazard model showed that anticholinergic medication administration was related to a higher risk for reaching the end‐point (crude hazard ratio: 3.62, 95% confidence interval: 1.45–9.04, P < 0.01; adjusted hazard ratio: 4.54, 95% confidence interval: 1.03–20.0, P < 0.05). In contrast, Mini‐Mental State Examination score, Charlson Comorbidity Index, and the number of drugs were not major risk factors for hospitalization in patients with dementia. Conclusion The Anticholinergic Risk Scale findings were shown to be a strong predictor of hospitalization for patients with dementia. We should evaluate the anticholinergic burden before initiating anti‐dementia therapy.