Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population‐based study

• Published in: Basic & clinical pharmacology & toxicology Vol. 124; no. 6; pp. 741 - 748
• Main Authors: Ah, Young‐Mi, Suh, Yewon, Jun, Kwanghee, Hwang, Sunghee, Lee, Ju‐Yeun
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.06.2019
• Subjects: Aged; Aged, 80 and over; Alzheimer’s disease; Anticholinergics; Cholinergic Antagonists - adverse effects; Cholinesterase; Cholinesterase inhibitors; Cholinesterase Inhibitors - therapeutic use; Cognitive ability; Cognitive Dysfunction - chemically induced; Cohort Studies; Confidence intervals; Delirium; Delirium - chemically induced; Delirium - epidemiology; Dementia; Dementia - drug therapy; Dementia - epidemiology; Dementia disorders; Female; Hospitalization; Humans; Inhibitors; Male; Mental disorders; Mortality; Older people; Patients; Population studies; Population-based studies; Regression analysis; Republic of Korea - epidemiology; Retrospective Studies; Statistical analysis; Republic of Korea; mortality; cholinesterase inhibitors; Alzheimer’s disease; anticholinergics; delirium
• ISSN: 1742-7835; 1742-7843
• DOI: 10.1111/bcpt.13184

Few studies have evaluated the association between anticholinergic burden and treatment modification after starting a cholinesterase inhibitor in clinical practice. We aimed to evaluate the effect of anticholinergic burden on anti‐dementia treatment modification, delirium and mortality. We retrospectively analysed older adults (n = 25 825) who started a cholinesterase inhibitor during 2003–2011 from Korean National Health Insurance Service Senior Cohort Database. High anticholinergic burden was defined as an average daily Anticholinergic Cognitive Burden (ACB) score of >3 during the first 3 months. We investigated the impact of high anticholinergic burden on the rate of treatment modification, delirium and mortality in comparison with minimal ACB (ACB score ≤1) in propensity‐matched cohorts (N = 7438). Approximately 6.0% of patients with dementia were exposed to a high anticholinergic burden within the first three months of treatment. In high anticholinergic burden cohorts, significantly more patients experienced treatment modification (34.9% vs. 32.1%) or delirium (5.6% vs. 3.6%) and the mortality rate was also higher (16.8% vs. 14.1%) than controls. A multivariate Cox proportional hazard regression analysis showed that an average ACB score >3 within the first three months significantly increased the risk of treatment modification (hazard ratio (HR): 1.12, 95% confidence interval (CI): 1.02‐1.24), delirium (HR: 1.52, CI: 1.17‐1.96) and mortality (HR: 1.23, CI: 1.06‐1.41). This study showed that high anticholinergic burden negatively affected the treatment response to cholinesterase inhibitors and that an average ACB score >3 was an independent prognostic factor for delirium or mortality in dementia patients.