title: Associations between Anticholinergic Burden and Adverse Health Outcomes in Parkinson Disease.
abstract: BACKGROUND
  Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on anticholinergic burden are limited in subpopulations, such as individuals with Parkinson disease (PD). The objective of this study was to determine whether anticholinergic burden was associated with adverse outcomes in a PD inpatient population.
  
  
  METHODS
  Using the Cerner Health Facts® database, we retrospectively examined anticholinergic medication use, diagnoses, and hospital revisits within a cohort of 16,302 PD inpatients admitted to a Cerner hospital between 2000 and 2011. Anticholinergic burden was computed using the Anticholinergic Risk Scale (ARS). Primary outcomes were associations between ARS score and diagnosis of fracture and delirium. Secondary outcomes included associations between ARS score and 30-day hospital revisits.
  
  
  RESULTS
  Many individuals (57.8%) were prescribed non-PD medications with moderate to very strong anticholinergic potential. Individuals with the greatest ARS score (≥ 4) were more likely to be diagnosed with fractures (adjusted odds ratio (AOR): 1.56, 95% CI: 1.29-1.88) and delirium (AOR: 1.61, 95% CI: 1.08-2.40) relative to those with no anticholinergic burden. Similarly, inpatients with the greatest ARS score were more likely to visit the emergency department (adjusted hazard ratio (AHR): 1.32, 95% CI: 1.10-1.58) and be readmitted (AHR: 1.16, 95% CI: 1.01-1.33) within 30-days of discharge.
  
  
  CONCLUSIONS
  We found a positive association between increased anticholinergic burden and adverse outcomes among individuals with PD. Additional pharmacovigilance studies are needed to better understand risks associated with anticholinergic medication use in PD.
authors.affiliation: McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada.|Fulbright Canada Student, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
authors.forename: James A G
authors.initials: JA
authors.lastname: Crispo
authors.affiliation: Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.|Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.|Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.
authors.forename: Allison W
authors.initials: AW
authors.lastname: Willis
authors.affiliation: Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.|Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.|Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.
authors.forename: Dylan P
authors.initials: DP
authors.lastname: Thibault
authors.affiliation: McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Fortin
authors.affiliation: Cerner Corporation, Kansas City, Missouri, United States of America.
authors.forename: Harlen D
authors.initials: HD
authors.lastname: Hays
authors.affiliation: Cerner Corporation, Kansas City, Missouri, United States of America.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: McNair
authors.affiliation: C. T. Lamont Primary Health Care Research Centre, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Bruyère Research Institute, Ottawa, Ontario, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Lise M
authors.initials: LM
authors.lastname: Bjerre
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Dafna E
authors.initials: DE
authors.lastname: Kohen
authors.affiliation: Cardiology Research Institute, University of Buenos Aires, National Research Council (ININCA-UBA-CONICET), Buenos Aires, Argentina.
authors.forename: Santiago
authors.initials: S
authors.lastname: Perez-Lloret
authors.affiliation: McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada.|Risk Sciences International, Ottawa, Ontario, Canada.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Mattison
authors.affiliation: McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada.|Risk Sciences International, Ottawa, Ontario, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Krewski
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D003072:Cognition Disorders / Q000139:chemically induced / Q000150:complications; D015331:Cohort Studies; D016208:Databases, Factual; D003693:Delirium / Q000139:chemically induced / Q000150:complications; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000517:prevention & control; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000628:therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D018680:Cholinergic Antagonists