Anticholinergic Medications and Parent-Reported Anticholinergic Symptoms in Neurologically Impaired Children
James A Feinstein1, Chris Feudtner1, Allison Kempe1
1Adult and Child Center for Health Outcomes Research & Delivery Science (ACCORDS) (J.A.F.,A.K.), University of Colorado and Children's Hospital Colorado, Aurora, Colorado, USA; Division of General Pediatrics, Department of Pediatrics (C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Skaggs School of Pharmacy & Pharmaceutical Sciences (L.E.O.), University of Colorado, Aurora, Colorado, USA.
Insights
Children on multiple medications with high anticholinergic burden scores experienced more side effects. This suggests reviewing and potentially reducing anticholinergic medication use in pediatric patients with neurological impairments.
Area of Science:
- Pediatric Pharmacology
- Clinical Pharmacy
- Neurology
Background:
- Children with severe neurological impairment often use multiple medications (polypharmacy).
- Anticholinergic (AC) medications carry risks of side effects, but this is understudied in children.
- Anticholinergic Cognitive Burden (ACB) scores quantify medication regimen AC load, with scores ≥3 linked to adverse outcomes in adults.
Purpose of the Study:
- To assess the relationship between ACB scores and parent-reported AC symptoms in children.
- To investigate the association between high ACB scores and anticholinergic side effects in a pediatric population with neurological impairment.
Main Methods:
- Cross-sectional study of 123 children (1-18 years) with severe neurological impairment and polypharmacy.
- Calculated total ACB scores for all prescribed medications.
- Used logistic regression to analyze the association between ACB scores ≥3 and parent-reported AC symptoms, adjusting for covariates.
Main Results:
- 87% of children were prescribed AC medications.
- 44% had ACB scores ≥3 for scheduled medications.
- Elevated ACB scores (≥3) were significantly associated with increased odds of experiencing ≥1 AC symptom.
Conclusions:
- High ACB scores in children with neurological impairment correlate with increased anticholinergic symptoms.
- Clinicians should consider deprescribing unnecessary AC medications in this vulnerable population.
- Further research in larger cohorts is warranted to confirm these findings.
Context:
Children with severe neurological impairment and polypharmacy are exposed to anticholinergic (AC) medications that may have anticholinergic side effects, but this is understudied. Anticholinergic Cognitive Burden (ACB) scores measure total anticholinergic burden for a medication regimen, and scores ≥3 have been associated with increased morbidity and mortality in adults.
Objective:
We assessed the relationship between ACB scores and parent-reported anticholinergic symptoms in children.
Methods:
Cross-sectional study of patients one to 18 years-old with ICD-defined severe neurological impairment and polypharmacy. At routine clinical visits, total ACB scores were computed for all medications. Parent-reported AC symptoms (constipation, drowsiness, difficulty concentrating, dry mouth, or urinary problems) were assessed. Multivariable logistic regression was used to test the association between total ACB scores ≥3 for scheduled medications and the presence of AC symptoms, adjusted for age and recent acute healthcare utilization.
Results:
Among 123 unique patients, 87% were prescribed AC medications. Common AC medication classes included: systemic antihistamines (64%), anxiolytics (53%), antidepressants (30%), H2 blockers (22%), and muscle relaxants (20%). Total ACB scores ≥3 were observed in 44% for scheduled medications and in 63% of patients for scheduled plus PRN medications. Total ACB scores ≥3 were significantly associated with an increased odds of ≥1 anticholinergic symptoms for scheduled medications (OR: 3.1; 95% CI: 1.4, 6.7) and for scheduled plus PRN medications (OR: 2.9; 95% CI: 1.3, 6.4).
Conclusion:
If replicated in larger populations, the association between elevated total ACB scores and anticholinergic side effects in children should prompt clinicians to consider deprescribing potentially unneeded anticholinergic medications.
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