Background Drugs with anticholinergic properties have harmful effects among older people and they may antagonise the effects of cholinesterase inhibitors (ChEIs). Although concomitant use of both may lead to worsening cognitive impairment, anticholinergics are frequently used with ChEIs.

Purpose To analyse the anticholinergic risk in elderly nursing home patients treated with ChEIs.

Material and methods We conducted a cross-sectional study of elderly patients with dementia who were residing in two nursing homes and taking ChEIs in September 2017. Anticholinergic risk assessment was determined using the Anticholinergic Risk Scale (ARS). The ARS assigns each drug therapy a score according to its risk of anticholinergic adverse effects (0=none, 1=moderate, 2=strong, 3=very strong). These points are added together to produce the individual’s ARS score. ARS was selected because it provides a more conservative estimate of anticholinergic burden than other scales. Collected data, from digital medical records, included sex, age and drugs prescribed and they were processed using SPSS.

Results From the whole group of patients residing in the nursing homes (n=311), 48 patients (15.4%) were treated with ChEIs: 87.5% females, mean age 83.5±6.3, mean prescribed drugs: 8.9±2.3. Fifteen patients (31.2%) were taking memantine, 13 (27.1%) rivastigmine, 12 (25%) donepezile and eight (16.7%) memantine plus rivastigmine or donepezile.

Twenty patients with dementia were not prescribed anticholinergic drug therapy. According to ARS, 28 patients (58.3%) were taking at least one anticholinergic drug, 39 drugs whole. There were 18 patients (37.5%) with low risk (ARS=1); 10 (20.8%) with medium risk (ARS=2) and only one (2.1%) with high risk (ARS ≥3). For those patients with an ARS score of 1 or more, the anticholinergic risks of the prescribed drug therapies were: score=1: quetiapine (11 patients), trazodone (nine), risperidone (four), mirtazapine (four), ranitidine (four), haloperidol (three), levodopa-carbidopa (two), paroxetine (one); and score=3: chlorpromazine (one).

Conclusion Concomitant use of anticholinergic drugs and ChEIs is common among older adults. Higher ARS scores have been shown to have a significant association with anticholinergic adverse effects, including memory decline, so the findings of this study suggest the need to consider alternatives with lower anticholinergic effects.

No conflict of interest