Anticholinergic Drug Burden in Older People's Brain - How well is it Measured?
Open accessAbstract
Concurrent use of several drugs with potential anticholinergic properties is highly prevalent in the elderly. Methods to determine the overall anticholinergic drug burden have been developed to estimate the risk of central anticholinergic adverse effects. The objective of this MiniReview was to critically appraise the clinical utility of the methods used to assess the anticholinergic drug burden in older people's brain. We evaluated the in vitro method used to measure the anticholinergic activity in a patient's serum and the four anticholinergic drug scales: Anticholinergic Risk Scale, Anticholinergic Cognitive Burden, Drug Burden Index and Anticholinergic Drug Scale. Medline searches of the literature from January 1988 to January 2013 were performed. Studies that related anticholinergic drug burden to central adverse outcomes in elderly people were included, while case reports and studies of single substances were excluded. Despite the consistently reported association between a high anticholinergic drug burden and negative cognitive and psychomotor outcomes in older patients, there are discrepancies in the literature. Furthermore, no significant cognitive improvements after the anticholinergic drug burden was reduced have been shown in randomized controlled trials. It is reasonable to question whether the estimated anticholinergic drug burden can predict the overall brain effects of multiple anticholinergic agents in older people.
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AP treatment often exposes patients to a high anticholinergic burden (ACB) through competitive inhibition of muscarinic receptors and the subsequent acetylcholine-mediated response.
“AP treatment often exposes patients to a high anticholinergic burden (ACB) through competitive inhibition of muscarinic receptors and the subsequent acetylcholine-mediated response84.”
From Autonomic nervous system dysfunction in schizophrenia: impact on cognitive and metabolic health (2021) · cites this paper as [84]
The Mechanism of Action section says anticholinergic drugs competitively bind muscarinic receptors and inhibit acetylcholine-mediated responses. The serum anticholinergic activity section reports increased activity within therapeutic ranges for three atypical antipsychotics, but not for three others; it does not establish that antipsychotic treatment often produces a high anticholinergic burden. Page numbers are unavailable in our copy. (LLM, conf=0.89)
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- Authors
- Kersten, H., & Wyller, T. B.
- Affiliations
- Sykehuset i Vestfold (NO)
- Oslo University Hospital (NO)
- Corresponding author
- Kersten, Hege
- Venue
- Basic & Clinical Pharmacology & Toxicology
- Publisher
- Wiley
- Published
- 2013-10-19
- Volume
- 114
- Issue
- 2
- Pages
- 151-159
- ISSN
- 1742-7835 (ISSN-L)
- OpenAlex
- W1972142078
- Cited by
- 112
- References
- 75
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 7 · 2023: 7 · 2022: 7 · 2021: 15 · 2020: 18 · 2019: 13 · 2018: 3 · 2017: 7 · 2016: 13 · 2015: 10 · 2014: 5
- FWCI
- 0.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Basic & Clinical Pharmacology & Toxicology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Pharmacology › Cholinesterase and Neurodegenerative Diseases
- Keywords
- anticholinergic burden, polypharmacy, older adults, anticholinergic effects, Anticholinergic Risk Scale, anticholinergic cognitive burden, Drug Burden Index, Anticholinergic Drug Scale, cognitive impairment, psychomotor impairment
- MeSH terms
- Aged, Brain, Humans, Randomized Controlled Trials as Topic, Cholinergic Antagonists, Drug-Related Side Effects and Adverse Reactions, Observational Studies as Topic
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