Anticholinergic prescribing habits and its associations in a community population of people living with dementia.

Introduction:

Many commonly prescribed medications have inadvertent anticholinergic effects. People living with Dementia (PLWD) are vulnerable to these effects and at risk of adverse outcomes, the risk being higher with greater anticholinergic exposure. We investigated prescribing patterns and anticholinergic burden (ACB) in a cohort of community-dwelling PLWD and explored the effect of ACB on cognition, neuropsychiatric symptoms, quality of life (QoL), and functional independence.

Method:

The medication and demographic information for 87 (39 female) community-dwelling PLWD were obtained from Electronic Care Summaries. We used the German Anticholinergic Burden Scale (GABS) to measure ACB. Additionally, we investigated associations between ACB and cognitive(ADAS-Cog), functional(BADL), neuropsychiatric (NPI) and QoL(DemQoL) assessments.

Results:

28.7% of participants had a clinically significant score (ACB> 2). The most commonly prescribed medications with ACB were Lansoprazole(18.3%), Mirtazapine(12.6%) and Codeine(12.6%). ACB was higher in males and negatively correlated with age, r(87)=-.21,p=.03. There was no association between ACB and cognition, QoL, functional independence, and neuropsychiatric symptoms. Over six months, PLWD with no ACB had a greater negative change in neuropsychiatric symptoms[t(18)=2.27,p=.04] and functional independence[t(23)=-3.8,p=.001], indicating greater dependence and worsening neuropsychiatric symptoms.

Conclusion:

A third of PLWD in the community had clinically significant ACB. No ACB was associated with worsening neuropsychiatric symptoms and functional dependence over a six-month period. Community prescribers should consider regular medication reviews with PLWD and carers to ensure medications are prescribed safely and appropriately.