Many older patients who are prescribed cholinesterase inhibitors for dementia or Alzheimer’s disease are also taking anticholinergic drugs that can worsen their cognition, says a team of researchers from the Institute for Clinical Evaluative Sciences (ICES) and Women's College Hospital.
March 23, 2016 | Download Release
Many older patients who are prescribed cholinesterase inhibitors for dementia or Alzheimer’s disease are also taking anticholinergic drugs that can worsen their cognition, says a team of researchers from the Institute for Clinical Evaluative Sciences (ICES) and Women's College Hospital. The risk of this drug combination is especially high when the patient sees multiple physicians or lives in a long-term care facility.
"Although prescribing anticholinergic drug therapy to persons with dementia is generally considered inappropriate, these therapies are often prescribed in clinical practice," says Dr. Paula Rochon, lead researcher on the study who is a senior core researcher at ICES and vice-president of research at Women’s College Hospital. "Anticholinergic drug therapy prescribed together with cholinesterase inhibitor drug therapy is particularly concerning, since the cognitive benefits gained from one drug are undone by the other."
Anticholinergics are a class of drugs that block the action of the neurotransmitter acetylcholine in the brain. They are commonly prescribed to treat a wide range of illnesses including asthma, incontinence, intestinal cramps, muscle spasms, depression and sleep disorders. Because of their frequent layering and multiple adverse effects including cognitive impairment, a tool called the Anticholinergic Risk Scale (ARS) has been developed to estimate the risk of adverse effects from anticholinergic medications using a range from zero (no risk) to three and up (high risk).
Published online this week in the Journal of the American Geriatrics Society, the study analyzes the anonymized records of older adults who had been newly dispensed cholinesterase inhibitor drugs, usually prescribed for dementia or Alzheimer’s disease. The researchers divided the population into two groups: one group was composed of 79,067 community-dwelling patients (at a mean age of 81), and the other group consisted of 12,113 long-term care residents (at a mean age of 84).
In the community-dwelling group:
In the long-term care group:
“We know from previous studies that having multiple prescribers is linked to an increase in polypharmacy, potential drug interactions, and adverse events,” says Christina Reppas-Rindlisbacher, the study’s lead researcher and an MD candidate at the University of Toronto. “Older adults with dementia and multiple comorbid conditions are particularly vulnerable to this risk because they often receive care from multiple physicians, who may not be communicating well with each other. Given the potential risks of anticholinergic drug use, we suggest that improving communication amongst physicians and checking ARS risk scores prior to prescribing any new drug therapy are important strategies to ensure that these vulnerable patients receive the best possible care.”
“Anticholinergic drug burden in persons with dementia taking a cholinesterase inhibitor: The effect of multiple physicians” was published this week in the Journal of the American Geriatrics Society.
Author block: Christina E. Reppas-Rindlisbacher, Hadas D. Fischer, Kinwah Fung, Sudeep S. Gill, Dallas Seitz, Cara Tannenbaum, Peter C. Austin and Paula A. Rochon.
-30-Jump to top page