Potentially inappropriate prescriptions of anticholinergics drugs in Alzheimer's disease patients

Geriatr Gerontol Int. 2019 Sep;19(9):913-917. doi: 10.1111/ggi.13748. Epub 2019 Jul 24.

Abstract

Aim: Alzheimer's disease is a common cause of dementia, and is usually treated with medications that elevate acetylcholine levels. The objective of the present study was to identify drugs with anticholinergic properties prescribed to patients diagnosed with Alzheimer's disease in Colombia.

Methods: A cross-sectional study was carried out in outpatients diagnosed with Alzheimer's disease who were identified from a population database from Colombia, and had been treated with cholinesterase inhibitors and glutamate N-methyl-D-aspartate receptor antagonists. The anticholinergic burden was evaluated using the Anticholinergic Cognitive Burden scale, and patients were classified on a scale of 0-3 points according to anticholinergic potential, and were grouped into those with mild-to-moderate (1-2 points) or high (≥3 points) anticholinergic load.

Results: The study included 4134 Alzheimer's disease patients. The mean age was 81.50 ± 8.16 years, and 67.8% were women. At least 22.9% of patients took anticholinergic drugs. Of these, the most frequently prescribed medication was quetiapine (8.6%). Age >85 years was associated with a high risk of having an anticholinergic burden ≥3 points (OR 2.19, 95%CI 1.159-4.162). Potential interactions between cholinesterase inhibitors and anticholinergic drugs were identified in 7.8% of patients.

Conclusions: The majority of patients who were prescribed anticholinergic drugs were older women, had a significant total anticholinergic burden and had frequent pharmacological interactions with cholinesterase inhibitors. The use of anticholinergics reduces the clinical effectiveness of antidementia drugs and increases the risk of adverse reactions. Geriatr Gerontol Int 2019; 19: 913-917.

Keywords: Alzheimer's disease; cholinesterase inhibitors; muscarinic antagonists; pharmacovigilance; quetiapine fumarate.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alzheimer Disease* / diagnosis
  • Alzheimer Disease* / drug therapy
  • Alzheimer Disease* / epidemiology
  • Cholinergic Antagonists / therapeutic use
  • Cholinesterase Inhibitors / therapeutic use*
  • Colombia / epidemiology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Inappropriate Prescribing* / prevention & control
  • Inappropriate Prescribing* / statistics & numerical data
  • Male
  • Medication Therapy Management / standards
  • Medication Therapy Management / statistics & numerical data
  • Muscarinic Antagonists / therapeutic use*
  • Outpatients / statistics & numerical data
  • Pharmacovigilance
  • Potentially Inappropriate Medication List
  • Psychotropic Drugs / therapeutic use
  • Quetiapine Fumarate / therapeutic use*

Substances

  • Cholinergic Antagonists
  • Cholinesterase Inhibitors
  • Muscarinic Antagonists
  • Psychotropic Drugs
  • Quetiapine Fumarate