title: Potential benefits of reducing medication-related anticholinergic burden for demented older adults: a prospective cohort study.
abstract: OBJECTIVE
  Medication-related anticholinergic burden is a quality indicator for geriatric pharmacotherapy; however, little is known regarding the benefits of reducing anticholinergic burden for demented patients
  
  
  METHODS
  Demented residents in a Veteran Home were enrolled for this study and an educational program was held for primary care physicians providing services at the Veterans Home. Residents were assigned to the intervention group if the primary care team could adhere to the research protocol and the remaining residents were assigned to the reference group receiving conventional care. Anticholinergic burden was estimated by Clinician-Rated Anticholinergic Score (CR-ACHS). Healthcare outcomes; for example, hospitalizations, mortality, cognitive and physical function, were compared between groups.
  
  
  RESULTS
  Overall, 53 of the 67 demented residents (mean age 83.4 ± 4.4 years) completed this study. Anticholinergic exposure was found in 38 participants (56.7%) at baseline, in which antipsychotics (n=29, 76.3%) and antidepressants (n=19, 50%) were the most common agents. Compared with participants in the reference group, CR-ACHS was significantly reduced in the intervention group at 12-week follow up (intervention group vs reference group=0.5 ± 1.1 vs 1.1 ± 1.3, P=0.021), whereas the mean Mini-Mental State Examination and Barthel Index were similar between groups. In contrast, no clinical complication was observed regarding medication adjustments during the study period.
  
  
  CONCLUSIONS
  Anticholinergic burden can be successfully and safely reduced through an educational program for primary care physicians, but the benefit of reducing anticholinergic burden remained unclear within the first 12 weeks. Further investigation is required to evaluate the long-term benefits of reducing anticholinergic burden for demented older adults.
authors.affiliation: Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yen-Chi
authors.initials: YC
authors.lastname: Yeh
authors.forename: Chien-Liang
authors.initials: CL
authors.lastname: Liu
authors.forename: Li-Ning
authors.initials: LN
authors.lastname: Peng
authors.forename: Ming-Hsien
authors.initials: MH
authors.lastname: Lin
authors.forename: Liang-Kung
authors.initials: LK
authors.lastname: Chen
mesh_terms: D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014728:Veterans
chemical_list: D018680:Cholinergic Antagonists