title: Association of anticholinergic burden with cognitive and functional status in a cohort of hospitalized elderly: comparison of the anticholinergic cognitive burden scale and anticholinergic risk scale: results from the REPOSI study.
abstract: BACKGROUND
  Drugs with anticholinergic effects are associated with adverse events such as delirium and falls as well as cognitive decline and loss of independence.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the association between anticholinergic burden and both cognitive and functional status, according to the hypothesis that the cumulative anticholinergic burden, as measured by the Anticholinergic Cognitive Burden (ACB) Scale and Anticholinergic Risk Scale (ARS), increases the risk of cognitive decline and impairs activities of daily living.
  
  
  METHODS
  This cross-sectional, prospective study (3-month telephone follow-up) was conducted in 66 Italian internal medicine and geriatric wards participating in the Registry of Polytherapies SIMI (Società Italiana di Medicina Interna) (REPOSI) study during 2010. The sample included 1,380 inpatients aged 65 years or older. Cognitive status was rated with the Short Blessed Test (SBT) and physical function with the Barthel Index. Each patient's anticholinergic burden was evaluated using the ACB and ARS scores.
  
  
  RESULTS
  The mean SBT score for patients treated with anticholinergic drugs was higher than that for patients receiving no anticholinergic medications as also indicated by the ACB scale, even after adjustment for age, sex, education, stroke and transient ischaemic attack [9.2 (95 % CI 8.6-9.9) vs. 8.5 (95 % CI 7.8-9.2); p = 0.05]. There was a dose-response relationship between total ACB score and cognitive impairment. Patients identified by the ARS had more severe cognitive and physical impairment than patients identified by the ACB scale, and the dose-response relationship between this score and ability to perform activities of daily living was clear. No correlation was found with length of hospital stay.
  
  
  CONCLUSIONS
  Drugs with anticholinergic properties identified by the ACB scale and ARS are associated with worse cognitive and functional performance in elderly patients. The ACB scale might permit a rapid identification of drugs potentially associated with cognitive impairment in a dose-response pattern, but the ARS is better at rating activities of daily living.
authors.affiliation: Laboratory for Quality Assessment of Geriatric Therapies and Services, Drug Information Service for the Elderly, Mario Negri Institute for Pharmacological Research, Via Giuseppe La Masa, 19, 20156 Milan, Italy. luca.pasina@marionegri.it
authors.forename: Luca
authors.initials: L
authors.lastname: Pasina
authors.forename: Codjo D
authors.initials: CD
authors.lastname: Djade
authors.forename: Ugo
authors.initials: U
authors.lastname: Lucca
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nobili
authors.forename: Mauro
authors.initials: M
authors.lastname: Tettamanti
authors.forename: Carlotta
authors.initials: C
authors.lastname: Franchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Salerno
authors.forename: Salvatore
authors.initials: S
authors.lastname: Corrao
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marengoni
authors.forename: Alfonso
authors.initials: A
authors.lastname: Iorio
authors.forename: Maura
authors.initials: M
authors.lastname: Marcucci
authors.forename: Francesco
authors.initials: F
authors.lastname: Violi
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D003071:Cognition / Q000187:drug effects; D003072:Cognition Disorders / Q000139:chemically induced* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D011446:Prospective Studies
chemical_list: D018680:Cholinergic Antagonists