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Threshold for a Reduction in Anticholinergic Burden to Decrease Behavioral and Psychological Symptoms of Dementia.

Yacine Jaïdi1, Adrien Guilloteau2, Vignon Nonnonhou3

  • 1Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France; Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France.

Journal of the American Medical Directors Association
|December 4, 2018
PubMed
Summary

Reducing anticholinergic burden (AB) in dementia patients with behavioral and psychological symptoms (BPSDs) can significantly improve symptoms. A small reduction in AB, particularly with the Anticholinergic Drug Scale (ADS), is linked to decreased BPSD frequency and severity.

Keywords:
Cholinergic antagonistbehavioral disordersdementiadrug effectsolder

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Area of Science:

  • Geriatric Medicine
  • Pharmacology
  • Neuroscience

Background:

  • High anticholinergic burden (AB) is frequently associated with behavioral and psychological symptoms (BPSDs) in dementia patients.
  • BPSDs are a common reason for hospitalization in this population.

Purpose of the Study:

  • To identify the threshold reduction in AB correlating with clinically significant improvement in BPSDs.
  • To assess the impact of AB reduction on BPSD frequency, severity, and disruptiveness.

Main Methods:

  • Prospective study in a dedicated geriatric care unit.
  • Included 147 hospitalized dementia patients with BPSDs.
  • Assessed AB using Anticholinergic Drug Scale (ADS), Anticholinergic Cognitive Burden scale (ACB), and Anticholinergic Risk Scale (ARS).
  • Defined clinically significant BPSD improvement as a 4-point reduction in the Neuropsychiatric Inventory-Nursing Home (NPI-NH) frequency × severity (F×S) score.

Main Results:

  • A 2-point reduction in AB (using ADS) correlated with significant improvement in BPSD F×S score for moderate-intensity BPSDs.
  • A 3-point reduction in AB (using ADS) was associated with improved occupational disruptiveness scores.

Conclusions:

  • Reducing anticholinergic burden is advisable in older dementia patients with BPSDs.
  • Preferring medications with lower AB may mitigate BPSD frequency, severity, and disruptiveness.
  • Standardized AB assessment and reduction strategies are warranted for dementia patients with BPSDs.