title: Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: a randomized controlled trial.
abstract: BACKGROUND
  Observational studies report a relationship between anticholinergic drug scale (ADS) score and cognitive function. This study investigated whether a reduced ADS score improved cognitive function in a frail elderly population.
  
  
  METHODS
  This randomized, controlled, single-blinded trial, recruited long-term residents with an ADS score of greater than or equal to 3 from 22 nursing homes in Norway. The participants were randomly allocated (1:1) to intervention or control. The intervention was a pharmacist-initiated reduction of ADS score after multidisciplinary drug reviews. Primary end point was Consortium to Establish a Registry for Alzheimer's Disease 10-wordlist test for immediate recall. Secondary end points were Mini-Mental Sate Examination, delayed recall and recognition of words, saliva flow, and serum anticholinergic activity (SAA).The participants were retested after 4 and 8 weeks, and the study groups were compared after adjusting for baseline differences.
  
  
  RESULTS
  Eighty-seven patients were included. The median ADS score was reduced by 2 units (p < .0001) in the intervention group and remained unchanged in the control group. After 8 weeks, the adjusted mean difference in immediate recall was 0.54 words between the intervention and control group (95% confidence interval [CI]: -0.91, 2.05; p = .48). The study groups did not differ significantly in any of the other cognitive end points, salvia flow, or SAA at either follow-up (p > .18).
  
  
  CONCLUSIONS
  Pharmacist-initiated drug changes significantly reduced ADS score but did not improve cognitive function in nursing home residents. Moreover, the drug changes did not reduce SAA or mouth dryness significantly, which might indicate limited applicability of the ADS score to prevent prescription risks in this population.
authors.affiliation: Department of Geriatric Medicine, Oslo University Hospital, Norway. hege.kersten@medisin.uio.no
authors.forename: Hege
authors.initials: H
authors.lastname: Kersten
authors.forename: Espen
authors.initials: E
authors.lastname: Molden
authors.forename: Inga Kristin
authors.initials: IK
authors.lastname: Tolo
authors.forename: Eva
authors.initials: E
authors.lastname: Skovlund
authors.forename: Knut
authors.initials: K
authors.lastname: Engedal
authors.forename: Torgeir Bruun
authors.initials: TB
authors.lastname: Wyller
mesh_terms: D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects* / Q000097:blood; D003071:Cognition; D017723:Drug Utilization Review; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D011939:Mental Recall; D009483:Neuropsychological Tests; D009735:Nursing Homes; D010595:Pharmacists; D012472:Salivation; D016037:Single-Blind Method
chemical_list: D018680:Cholinergic Antagonists