Abstract
Objectives
Anticholinergic burden is detrimental to cognitive health.
Multiple studies found that a high anticholinergic burden is associated with an increased risk for dementia, changes to the brain structure, function, and cognitive decline.
We performed a post hoc analysis of a randomized controlled deprescribing trial. We compared the effect of the intervention on baseline anticholinergic burden across the treatment and control groups and the time of recruitment before and after a lockdown due to the COVID pandemic with subgroup analyses by baseline frailty index.
Design
Randomized controlled trial.
Settings and Participants
We analyzed data from a de-prescribing trial of older adults (>65 years) previously conducted in New Zealand that was focused on reducing the Drug Burden Index (DBI).
Methods
We used the anticholinergic cognitive burden (ACB) to quantify the impact of the intervention on reducing the anticholinergic burden. Participants not taking anticholinergics at the start of the trial were excluded. The primary outcome for this subgroup analysis was a change in ACB, measured with the ĝHedges statistic describing the difference in standard deviation units of this change between intervention and control. For this analysis, the trial participants were stratified into low, medium, and high frailty and timing into prior- and post-lockdown (public health measures for COVID-19).
Results
Among the 295 participants in this analysis, the median (IQR) age was 79 (74, 85), and 67% were women. For the primary outcome ĝHedges = −0.04 (95% CI −0.26 to 0.19) with a −0.23 mean reduction in ACB in the intervention arm and −0.19 in the control arm. Before lockdown ĝHedges = −0.38 (95% CI −0.84 to 0.04) and post-lockdown ĝHedges = 0.07 (95% CI −0.19 to 0.33). The mean change in ACB for each of the frailty strata was as follows: low frailty (−0.02; 95% CI −0.65 to 0.18); medium frailty (0.05; 95% CI −0.28 to 0.38); high frailty (0.08; 95% CI −0.40 to 0.56).
Conclusions and Implications
The study did not provide evidence for the effect of pharmacist deprescribing intervention on reducing the anticholinergic burden. However, this post hoc analysis examined the impact of COVID on the effectiveness of the intervention, and further research in this area may be warranted.
Anticholinergic burden is detrimental to cognitive health.
Multiple studies found that a high anticholinergic burden is associated with an increased risk for dementia, changes to the brain structure, function, and cognitive decline.
We performed a post hoc analysis of a randomized controlled deprescribing trial. We compared the effect of the intervention on baseline anticholinergic burden across the treatment and control groups and the time of recruitment before and after a lockdown due to the COVID pandemic with subgroup analyses by baseline frailty index.
Design
Randomized controlled trial.
Settings and Participants
We analyzed data from a de-prescribing trial of older adults (>65 years) previously conducted in New Zealand that was focused on reducing the Drug Burden Index (DBI).
Methods
We used the anticholinergic cognitive burden (ACB) to quantify the impact of the intervention on reducing the anticholinergic burden. Participants not taking anticholinergics at the start of the trial were excluded. The primary outcome for this subgroup analysis was a change in ACB, measured with the ĝHedges statistic describing the difference in standard deviation units of this change between intervention and control. For this analysis, the trial participants were stratified into low, medium, and high frailty and timing into prior- and post-lockdown (public health measures for COVID-19).
Results
Among the 295 participants in this analysis, the median (IQR) age was 79 (74, 85), and 67% were women. For the primary outcome ĝHedges = −0.04 (95% CI −0.26 to 0.19) with a −0.23 mean reduction in ACB in the intervention arm and −0.19 in the control arm. Before lockdown ĝHedges = −0.38 (95% CI −0.84 to 0.04) and post-lockdown ĝHedges = 0.07 (95% CI −0.19 to 0.33). The mean change in ACB for each of the frailty strata was as follows: low frailty (−0.02; 95% CI −0.65 to 0.18); medium frailty (0.05; 95% CI −0.28 to 0.38); high frailty (0.08; 95% CI −0.40 to 0.56).
Conclusions and Implications
The study did not provide evidence for the effect of pharmacist deprescribing intervention on reducing the anticholinergic burden. However, this post hoc analysis examined the impact of COVID on the effectiveness of the intervention, and further research in this area may be warranted.
| Original language | English |
|---|---|
| Pages (from-to) | 1253-1260 |
| Number of pages | 8 |
| Journal | Journal of the American Medical Directors Association |
| Volume | 24 |
| Issue number | 8 |
| Early online date | 17 Jun 2023 |
| DOIs | |
| Publication status | Published - 31 Aug 2023 |
Bibliographical note
This work was funded by the Health Research Council of New Zealand (grant 17/363).Keywords
- Anticholinergic burden
- controlled trial
- deprescribing
- older adults
- pharmacoepidemiology
- polypharmacy
ASJC Scopus subject areas
- Geriatrics and Gerontology
- Health Policy
- General Nursing
