Different methods, different results--how do available methods link a patient's anticholinergic load with adverse...

Area of Science:

• Geriatric Pharmacology
• Drug Safety and Pharmacoepidemiology

Background:

• Anticholinergic drugs can cause significant physical and cognitive impairment, especially in elderly patients.
• Anticholinergic load quantifies cumulative exposure to these medications.
• Existing methods for calculating anticholinergic load lack standardization.

Purpose of the Study:

• To review and compare different methods for calculating anticholinergic load.
• To identify discrepancies in the development and evaluation of these calculation methods.

Main Methods:

• Systematic literature search using PRISMA guidelines (PubMed, Sept 2014 - Aug 2015).
• Identified studies calculating anticholinergic load using scales or equations.
• Descriptively analyzed identification criteria, scoring, and outcome assessment methods.

Main Results:

• 55 studies using 12 scales and 1 equation were included.
• Significant discrepancies noted in drug identification criteria (8 types), scoring principles (2 types), and outcome measures (118 types).
• Effective methods incorporated drug dosage and potency; patient susceptibility and drug exposure modulators were rarely considered.

Conclusions:

• Varying outcome assessment methods limit comparability of current anticholinergic load calculations.
• Recommends calculating anticholinergic load using all available scales and equations for better outcome correlation.