title: Expert-based drug lists to measure anticholinergic burden: similar names, different results.
abstract: BACKGROUND
  Scoring scales such as the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS), and the Anticholinergic Cognitive Burden Scale (ACB) provide an estimation of total anticholinergic burden. Not all the lists include the same drugs, and the points given for certain drugs differ among them. Whether these discrepancies present important differences in the estimation of anticholinergic burden for an individual patient is unknown. Therefore, the aim of this study is to assess agreement among the three scales.
  
  
  METHODS
  Anticholinergic burden was measured with the three scales in 83 patients aged ≥65 years in a medium- and long-stay psychiatric hospital. Subsequently, patients were categorized into three risk categories: low risk (0 points), medium risk (1-2 points) or high risk (3 or more points). The chance-corrected measures of agreement for the different scores were determined with the k-statistic (kappa).
  
  
  RESULTS
  Values for kappa were: 0.19 for Anticholinergic Risk Scale-Anticholinergic Drug Scale, 0.21 for ACB-Anticholinergic Drug Scale and 0.25 for Anticholinergic Risk Scale-ACB. The mean anticholinergic burden measured with ACB was 3.28.
  
  
  CONCLUSIONS
  There is poor agreement among the three scales. These lists cannot be directly applied to different settings in which drug availability differs substantially, and they require periodic updates. Anticholinergic burden in our setting (psychogeriatric inpatients) was particularly high.
authors.affiliation: Red de Salud Mental de Araba, Vitoria, Spain. unax.lertxundietxebarria@osakidetza.net
authors.forename: Unax
authors.initials: U
authors.lastname: Lertxundi
authors.forename: Saioa
authors.initials: S
authors.lastname: Domingo-Echaburu
authors.forename: Rafael
authors.initials: R
authors.lastname: Hernandez
authors.forename: Javier
authors.initials: J
authors.lastname: Peral
authors.forename: Juan
authors.initials: J
authors.lastname: Medrano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D003071:Cognition / Q000187:drug effects; D003072:Cognition Disorders / Q000188:drug therapy* / Q000523:psychology; D017281:Cost of Illness; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D018680:Cholinergic Antagonists