Background Evidence suggests that medications with anticholinergic properties are frequently used in the elderly population, and these medications are associated with significant adverse effects and may lead to worsening of cognitive impairment. Concomitant use of drugs with anticholinergic properties and acetylcholinesterase inhibitors (AChEIs) may further impair cognition in patients with dementia.
Purpose To assess the use of drugs with anticholinergic properties in elderly nursing home patients treated with AChEIs.
Material and methods Observational and retrospective study of elderly patients with dementia treated with AChEIs residing in a nursing home in September 2015. Anticholinergic risk assessment was determined using the Anticholinergic Risk Scale (ARS). Data were obtained from pharmaceutical the managing program Farmatools.
Results 178 patients, 59.0% women. Mean age 85.6 ± 9.6 years (54–104). Mean prescribed drugs 9.4 ± 3.6 (2–20). According to ARS, 116 patients (65.2%) were taking at least one drug with anticholinergic properties.
From the whole group of patients, 32 patients (18%) with dementia were treated with AChEIs: 81.3% women, mean age 84.2 ± 7.3 years (71–101), mean prescribed drugs 8.4 ± 3.44 (3–17). 11 patients (34.3%) were taking rivastigmine, 11 (34.3%) donepezile, 7 (21.9%) memantine and 3 (9.5%) galantamine as AChEIs.
According to ARS, 21 patients (65.6%) were taking at least one drug with anticholinergic properties (rank 1–4), 41 drugs whole. Grade 1 risk: quetiapine 10 patients (24.5%), risperidone 9 (21.9%), trazodone 8 (19.5%), haloperidol 7 (17.2%), mirtazapine 3 (7.3%) and metoclopramide 1 (2.4%). Grade 2 risk: baclofen and tolterodine 1 patient each (2.4%). Grade 3 risk: butilescopolamine 1 patient (2.4%).
Average extent of anticholinergic exposure in all dementia patients: 1.41 ± 1.31 (0–4).
Conclusion A high percentage of elderly nursing home patients treated with AChEIs are taking drugs with anticholinergic properties.
The use of anticholinergic drugs may result in an increase in cognitive impairment, so the study findings suggest the need to consider alternatives with lower anticholinergic effects and promote evaluations of practices intended to improve care standards.
No conflict of interest.
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