title: Anticholinergic medications: an additional contributor to cognitive impairment in the heart failure population?
abstract: OBJECTIVE
  Patients with congestive heart failure (CHF) have a high prevalence of cognitive impairment and the association is multifactorial. In general, the burden of anticholinergic drugs has consistently been shown to be a risk factor for cognitive impairment in the elderly. The aim of this study was to assess the cognitive burden of medications in patients with CHF.
  
  
  METHODS
  This was a cross-sectional, retrospective, single-center study.
  
  
  METHODS
  The study was conducted in an outpatient setting.
  
  
  METHODS
  Patients who presented to a comprehensive heart failure clinic during a 1-month period were included.
  
  
  METHODS
  The primary outcomes of interest were mean anticholinergic cognitive burden (ACB) score of all medications and CHF medications (ACB-CHF), calculated based on the ACB Scoring Scale (ACB-SS). The ACB-CHF score was further dichotomized as 0 or 1 (low anticholinergic burden) versus 2 or 3 (high anticholinergic burden).
  
  
  RESULTS
  A total of 182 patients were included. The mean ACB and ACB-CHF scores were 2.4 (range 0-13) and 1.0 (range 0-4), respectively, while 25.8 % of patients had an ACB-CHF score of 2 or 3. There was no association found between ejection fraction in patients with systolic heart failure and the ACB (p = 0.28) or ACB-CHF (p = 0.62) score.
  
  
  CONCLUSIONS
  We conclude that patients with CHF have a substantial exposure to anticholinergic medications with adverse cognitive effects. This may be another important contributor to the increased prevalence of cognitive impairment in these patients.
authors.affiliation: Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA, arslan.shaukat@gmail.com.
authors.forename: Arslan
authors.initials: A
authors.lastname: Shaukat
authors.forename: Amir
authors.initials: A
authors.lastname: Habib
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Lane
authors.forename: Changyu
authors.initials: C
authors.lastname: Shen
authors.forename: Saba
authors.initials: S
authors.lastname: Khan
authors.forename: Yaron M
authors.initials: YM
authors.lastname: Hellman
authors.forename: Malaz
authors.initials: M
authors.lastname: Boustani
authors.forename: Adnan S
authors.initials: AS
authors.lastname: Malik
mesh_terms: D000368:Aged; D000375:Aging; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D003072:Cognition Disorders / Q000139:chemically induced* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006299:Health Services for the Aged; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D018680:Cholinergic Antagonists