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Jelaska J, Vučković M, Gugić Ordulj I, Kolak E, Šolić Šegvić L, Đapić Kolak Z, Keser I, Radić J. Unlocking Cognitive Potential: Association of Sarcopenia and Mediterranean Diet on Cognitive Function in Community-Dwelling Elderly of the Dalmatian Region. Nutrients 2024; 16:991. [PMID: 38613024 PMCID: PMC11013823 DOI: 10.3390/nu16070991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
The aim of this study was to determine the association between muscle strength, adherence to the Mediterranean diet (MeDi) and cognitive function in community-dwelling elderly. General data, data of body composition and anthropometric parameters, clinical and laboratory findings, cognitive test questionnaires (Mini-Mental State Examination-MMSE, Trail Making Test-TMT, Symbol Digit Modalities Test-SDMT), and nutritional assessments (Mini Nutritional Assessment-MNA, Mediterranean Diet Serving Score-MDSS) were obtained for each study participant. Handgrip strength (HS) was used as one of the key parameters for defining probable sarcopenia, among the Short Physical Performance Battery test (SPPB) (for defining physical activity) and the strength, assistance with walking, rising from a chair, climbing stairs, and falls questionnaire (SARC-F). Our cross-sectional study involved 114 participants aged ≥ 60 years, and two-thirds of the participants were female (76.3% vs. 23.7%). Probable sarcopenia was found in 34.7% of them. Using bivariate regression analysis, cognitive deficit among the sarcopenic population was associated with the following groups of collected data: (a) sociodemographic-associated factors-advanced age (OR: 1.07; p = 0.004), single marital status (OR: 3.25; p = 0.03), and low level of education (OR: 0.22; p < 0.003); (b) behavioral-associated factors-duration of institutionalization (OR: 1.05; p = 0.007), performance of heavy physical work (OR: 6.26; p = 0.001), low physical activity (OR: 0.08; p = 0.002), and risk of malnutrition (OR: 3.87; p = 0.005); (c) disease-related factors-loss of appetite (OR: 2.24; p = 0.04), information processing speed (OR: 0.88; p < 0.001), blood pressure systolic/diastolic variables (OR: 0.96/0.96; p = 0.002/0.02), medications (OR: 1.19; p = 0.005), predictive sarcopenia score ≥ 4 (OR: 3.1; p = 0.003), and low muscle strength (OR: 0.92; p = 0.002). Cognitive preservation among the sarcopenic population was associated with married status (OR: 0.23; p = 0.20), a high level of education (OR: 0.18; p = 0.002), smoking (OR: 0.33; p = 0.02), high physical activity (OR: 0.07; p < 0.001), and dietary habits using poultry (OR: 0.12; p = 0.004). The results suggest a significant association between sarcopenia and cognitive function in community-dwelling elderly, highlighting the need for regular nutritional interventions in this special population.
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Affiliation(s)
- Julija Jelaska
- Faculty of Food Technology and Biotechnology, University of Zagreb, 10000 Zagreb, Croatia; (J.J.); (I.G.O.)
| | - Marijana Vučković
- Internal Medicine Department, Nephrology and Haemodialysis Division, University Hospital of Split, 21000 Split, Croatia; (M.V.); (L.Š.Š.)
| | - Ivana Gugić Ordulj
- Faculty of Food Technology and Biotechnology, University of Zagreb, 10000 Zagreb, Croatia; (J.J.); (I.G.O.)
| | - Ela Kolak
- Nutrition and Dietetics Department, University Hospital of Split, 21000 Split, Croatia;
| | - Lucija Šolić Šegvić
- Internal Medicine Department, Nephrology and Haemodialysis Division, University Hospital of Split, 21000 Split, Croatia; (M.V.); (L.Š.Š.)
| | | | - Irena Keser
- Laboratory for Nutrition Science, Faculty of Food Technology and Biotechnology, University of Zagreb, 10000 Zagreb, Croatia;
| | - Josipa Radić
- Internal Medicine Department, Nephrology and Haemodialysis Division, University Hospital of Split, 21000 Split, Croatia; (M.V.); (L.Š.Š.)
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
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Michael HU, Enechukwu O, Brouillette MJ, Tamblyn R, Fellows LK, Mayo NE. The Prognostic Utility of Anticholinergic Burden Scales: An Integrative Review and Gap Analysis. Drugs Aging 2023; 40:763-783. [PMID: 37462902 DOI: 10.1007/s40266-023-01050-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Anticholinergic drugs are commonly prescribed, especially to older adults. Anticholinergic burden scales (ABS) have been used to evaluate the cumulative effects of multiple anticholinergics. However, studies have shown inconsistent results regarding the association between anticholinergic burden assessed with ABS and adverse clinical outcomes such as cognitive impairment, functional decline, and frailty. This review aims to identify gaps in research on the development, validation, and evaluation of ABS, and provide recommendations for future studies. METHOD A comprehensive search of five databases (MEDLINE, Embase, PsychInfo, CINAHL, CENTRAL) was conducted for relevant studies published from inception until 25 May 2023. Two reviewers screened for eligibility and assessed the quality of studies using different tools based on the study design and stage of the review framework. Research evidence was evaluated, and gaps were identified and grouped into evidence, knowledge, and methodological gaps, using evidence tables to summarize data. RESULTS Several evidence, knowledge, and methodological gaps in existing development, validation, and evaluation studies of ABS were identified. There is no universally accepted scale, and there is a need to define a clinically relevant threshold for measuring total anticholinergic burden. The current evidence has limitations, underrepresenting low- and middle-income countries, younger individuals, and populations with cognitive disabilities. The impact of anticholinergic burden on frailty is also understudied. Existing evaluation studies provide limited evidence on the benefit of reducing anticholinergic burden on clinical outcomes or the safety of anticholinergic deprescribing. There is also uncertainty regarding optimal reduction, clinically significant anticholinergic burden thresholds, and cost effectiveness. CONCLUSIONS Future research recommendations to bridge knowledge gaps include developing a risk assessment framework, refining ABS scales, establishing a standardized consensus scale, and creating a longitudinal measure of cumulative anticholinergic risk. Strategies to minimize bias, consider frailty, and promote multidisciplinary and multinational collaborations are also necessary to improve patient outcomes.
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Affiliation(s)
- Henry Ukachukwu Michael
- Division of Experimental Medicine, McGill University, Montreal, QC, Canada.
- Centre for Outcomes Research & Evaluation, Research Institute of McGill University Health Centre (RI-MUHC), 5252 de Maisonneuve, 2B:43, Montréal, QC, H4A 3S5, Canada.
| | | | - Marie-Josée Brouillette
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre (MUHC), Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, MUHC-RI, Montreal, QC, Canada
| | - Robyn Tamblyn
- Division of Experimental Medicine, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Lesley K Fellows
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Nancy E Mayo
- Division of Experimental Medicine, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of McGill University Health Centre (RI-MUHC), 5252 de Maisonneuve, 2B:43, Montréal, QC, H4A 3S5, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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Lim J, Jeong S, Jang S, Jang S. Hospitalization and emergency department visits associated with potentially inappropriate medication in older adults: self-controlled case series analysis. Front Public Health 2023; 11:1080703. [PMID: 37469702 PMCID: PMC10352109 DOI: 10.3389/fpubh.2023.1080703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/30/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Potentially inappropriate medications (PIM) and resulting adverse health outcomes in older adults are a common occurrence. However, PIM prescriptions are still frequent for vulnerable older adults. Here, we sought to estimate the risk of hospitalization and emergency department (ED) visits associated with PIM prescriptions over different exposure periods and PIM drug categories. Methods We used the National Health Insurance Service-Elderly Cohort Database (NHIS-ECDB) to construct the cohort and implemented a Self-Controlled Case Series (SCCS) method. Hospitalization or ED visits during the exposure and post-exposure periods were compared to those during the non-exposure period, and six PIM drug categories were evaluated. A conditional Poisson regression model was applied, and the risk of outcomes was presented as the incidence rate ratio (IRR). All potential time-varying covariates were adjusted by year. A total of 43,942 older adults aged ≥65 y who had at least one PIM prescription and the events of either hospitalization or ED visits between Jan 2016 and Dec 2019 were selected.. Results Mean days of each exposure period was 46 d (±123); risk was highest in exposure1 (1-7 d, 37.8%), whereas it was similar during exposure2 (15-28 d), and exposure3 (29-56 d) (16.6%). The mean number of total PIM drugs administered during the study period was 7.34 (±4.60). Both hospitalization and ED visits were significantly higher in both exposure (adjusted IRR 2.14, 95% Confidence Interval (CI):2.11-2.17) and post-exposure periods (adjusted IRR 1.41, 95% CI:1.38-1.44) in comparison to non-exposure period. The risk of adverse health outcomes was highest during the first exposure period (1-14 d), but decreased gradually over time. Among the PIM categories, pain medication was used the most, followed by anticholinergics. All PIM categories significantly increased the risk of hospitalization and ED visits, ranging from 1.18 (other PIM) to 2.85 (pain medication). Sensitivity analyses using the first incidence of PIM exposure demonstrated similar results. All PIM categories significantly increased the risk of hospitalization and ED visits, with the initial period of PIM prescriptions showing the highest risk. In subgroup analysis stratified by the number of medications, PIM effects on the risk of hospitalization and ED visits remained significant but gradually attenuated by the increased number of medications. Discussion Therefore, the development of deprescribing strategies to control PIM and polypharmacy collectively is urgent and essential.
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Affiliation(s)
- Jaeok Lim
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Sohyun Jeong
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Suhyun Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
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Chahine B, Al Souheil F, Yaghi G. Anticholinergic burden in older adults with psychiatric illnesses: A cross-sectional study. Arch Psychiatr Nurs 2023; 44:26-34. [PMID: 37197858 DOI: 10.1016/j.apnu.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/19/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVES We aimed in this study to determine the extent of exposure to anticholinergic drugs in older adults with psychiatric illnesses using the anticholinergic cognitive burden (ACB) scale and to identify the factors associated with anticholinergic drugs use and higher ACB scores. METHODS A cross-sectional study was conducted in the psychogeriatric division of an elderly care hospital. The study sample comprised all inpatients, aged ≥65 years, and diagnosed with psychiatric illness. RESULTS Anticholinergic drugs use was reported in 117 (79.6 %) patients, 76 (51.7 %) had an ACB score ≥ 3. Schizophrenia [OR = 5.4 (95 % CI 1.1-10.2), p = 0.02], anemia [OR = 2.2 (95 % CI 1.54-7.89), p = 0.01], and anticholinergic adverse effects [OR = 2.8 (95 % CI 1.12-7.07), p = 0.04] were significantly associated with a higher likelihood of using anticholinergic drugs. The odds of having an ACB score ≥ 3 over an ACB score = 0 were significantly increased by schizophrenia [OR = 4.9 (95 % CI 1.65-8.02), p = 0.01], anemia [OR = 1.32 (95 % CI 1.90-6.90), p = 0.02], and polypharmacy [OR = 1.74 (95 % CI 1.10-2.40), p = 0.04], while they were significantly decreased by age [OR = 0.86 (95 % CI 0.78-0.96), p < 0.001]. Patients with cognitive impairment were less likely than those without cognitive impairment to have an ACB score ≥ 3 over an ACB score = 0. CONCLUSIONS Our study revealed that older adults with psychiatric illnesses were exposed to high anticholinergic burden.
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Affiliation(s)
- Bahia Chahine
- PharmD Program, School of Pharmacy, Lebanese International University, Beirut, Lebanon.
| | - Farah Al Souheil
- PharmD Program, School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Gracia Yaghi
- PharmD Program, School of Pharmacy, Lebanese International University, Beirut, Lebanon
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Collin BG, Raju D, Katsikas S. The cognitive effects of anticholinergic drugs on apolipoprotein ε4 carriers and noncarriers in the Wisconsin Registry for Alzheimer's Prevention study. Neuropsychology 2021; 35:220-231. [PMID: 33764112 DOI: 10.1037/neu0000713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The purpose of the study was to test the hypothesis that anticholinergic drug exposure is associated with cognitive decline in the Wisconsin Registry for Alzheimer's Prevention (WRAP) study. Secondary aims were to assess if the effects of anticholinergic drugs on different domains of cognitive functioning varied for the entire sample and by apolipoprotein ε4 status. METHODS The WRAP study includes a sample of 1,573 subjects who self-reported medication use and were administered several cognitive tests four times over a decade. Partial correlations assessed relationships between reported days of definite anticholinergic drug exposure with changes in cognitive performance. Linear mixed models were conducted testing main effects for anticholinergic drug use and interaction effects between anticholinergic drug use, apolipoprotein ε4 status, and time on neuropsychological assessment performance. RESULTS Partial correlations indicated that days of anticholinergic drug exposure was associated with a decline in mental status for the entire sample (r = -.043, p = .011), and immediate verbal memory (r = -.066, p = .043), delayed verbal memory (r = -.077, p = .018), psychomotor speed (r = -.066, p = .043), and cognitive flexibility (r = -.067, p = .040) of apolipoprotein ε4 carriers only. The linear mixed-model results suggested that anticholinergic drug users had a greater decline than nonusers in delayed memory, psychomotor speed, and cognitive flexibility. Apolipoprotein ε4 carrier, anticholinergic drug users performed worse in delayed memory than nonusers and noncarrier, anticholinergic drug users. CONCLUSIONS Anticholinergic drug use may have deleterious effects on the cognitive functioning of subjects in populations at risk for dementia, especially among apolipoprotein ε4 carriers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Towards Appropriate Prescribing for Older Persons with Multiple Chronic Conditions. Arch Gerontol Geriatr 2021; 94:104397. [PMID: 33765568 DOI: 10.1016/j.archger.2021.104397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Preoperative Comparison of Three Anticholinergic Drug Scales in Older Adult Patients and Development of Postoperative Delirium: A Prospective Observational Study. Drugs Aging 2021; 38:347-354. [PMID: 33721289 PMCID: PMC8007502 DOI: 10.1007/s40266-021-00839-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative delirium (POD) is a frequent and serious complication after surgery. Evidence of a relationship between anticholinergic medication and the development of delirium is inconclusive, but studies on POD are rare. OBJECTIVES The objective of this study was to evaluate the anticholinergic load of preoperative medication in older adult patients and its association with the development of POD. METHODS This investigation was part of the European BioCog project ( http://www.biocog.eu ), a prospective multicenter observational study in older adult surgical patients (ClinicalTrials.gov identifier: NCT02265263, 15 October 2014). Patients with a Mini-Mental State Examination score ≤ 23 points were excluded. POD was assessed up to 7 days after surgery using the Nursing Delirium Screening Scale, Confusion Assessment Method and a patient chart review. The preoperative anticholinergic load was calculated using the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS) and the Anticholinergic Cognitive Burden Scale (ACBS), and associations with POD were analyzed using logistic regression analysis adjusting for age, comorbidities, duration of anesthesia and number of drugs used. RESULTS In total, 837 participants were included for analysis, and 165 patients (19.7%) fulfilled the criteria of POD. After adjusting for confounders, we found no association between preoperative anticholinergic load and the development of POD (ADS [points] odds ratio [OR] 0.928; 95% confidence interval [CI] 0.749-1.150; ARS [points] OR 0.832; 95% CI 0.564-1.227; ACBS [points] OR 1.045; 95% CI 0.842-1.296). CONCLUSION This study found no association between the anticholinergic load of drugs used preoperatively and the development of POD in older adult patients without severe preexisting cognitive impairment. Future analyses should examine the influence of intra- and postoperative administration of anticholinergic drugs as well as dosages of and interactions between medications.
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Pieper NT, Grossi CM, Chan WY, Loke YK, Savva GM, Haroulis C, Steel N, Fox C, Maidment ID, Arthur AJ, Myint PK, Smith TO, Robinson L, Matthews FE, Brayne C, Richardson K. Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis. Age Ageing 2020; 49:939-947. [PMID: 32603415 PMCID: PMC7583519 DOI: 10.1093/ageing/afaa090] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 03/09/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background the long-term effect of the use of drugs with anticholinergic activity on cognitive function remains unclear. Methods we conducted a systematic review and meta-analysis of the relationship between anticholinergic drugs and risk of dementia, mild cognitive impairment (MCI) and cognitive decline in the older population. We identified studies published between January 2002 and April 2018 with ≥12 weeks follow-up between strongly anticholinergic drug exposure and the study outcome measurement. We pooled adjusted odds ratios (OR) for studies reporting any, and at least short-term (90+ days) or long-term (365+ days) anticholinergic use for dementia and MCI outcomes, and standardised mean differences (SMD) in global cognition test scores for cognitive decline outcomes. Statistical heterogeneity was measured using the I2 statistic and risk of bias using ROBINS-I. Results twenty-six studies (including 621,548 participants) met our inclusion criteria. ‘Any’ anticholinergic use was associated with incident dementia (OR 1.20, 95% confidence interval [CI] 1.09–1.32, I2 = 86%). Short-term and long-term use were also associated with incident dementia (OR 1.23, 95% CI 1.17–1.29, I2 = 2%; and OR 1.50, 95% CI 1.22–1.85, I2 = 90%). ‘Any’ anticholinergic use was associated with cognitive decline (SMD 0.15; 95% CI 0.09–0.21, I2 = 3%) but showed no statistically significant difference for MCI (OR 1.24, 95% CI 0.97–1.59, I2 = 0%). Conclusions anticholinergic drug use is associated with increased dementia incidence and cognitive decline in observational studies. However, a causal link cannot yet be inferred, as studies were observational with considerable risk of bias. Stronger evidence from high-quality studies is needed to guide the management of long-term use.
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Affiliation(s)
| | | | | | | | | | | | | | - Chris Fox
- University of East Anglia, Norwich, UK
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López-Álvarez J, Sevilla-Llewellyn-Jones J, Agüera-Ortiz L. Anticholinergic Drugs in Geriatric Psychopharmacology. Front Neurosci 2019; 13:1309. [PMID: 31866817 PMCID: PMC6908498 DOI: 10.3389/fnins.2019.01309] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/22/2019] [Indexed: 12/31/2022] Open
Abstract
Drugs with anticholinergic action are widely prescribed in the elderly population due to their potential clinical benefits. However, these benefits are limited by adverse effects which may be serious in particular circumstances. This review presents different aspects of the use of anticholinergics in old age with a focus in psychogeriatric patients. We critically review published data on benefits and disadvantages of anticholinergics, which are often controversial. Prevalence, pathophysiology and measurement methods of the anticholinergic action of drugs are discussed. We also present the most important drawbacks resulting from its use, including effects on cognition in healthy and cognitively impaired people, in aged schizophrenia patients, emergence of delirium and psychiatric symptoms, influence in functionality, hospitalization, institutionalization and mortality, and the potential benefits and limitations of their discontinuation. Finally, we suggest practical recommendations for the safe use of anticholinergics in clinical conditions affecting elderly patients, such as dementia, schizophrenia and acute hallucinatory episodes, depression, anxiety, Parkinson's disease, cardiovascular conditions and urinary incontinence.
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Affiliation(s)
- Jorge López-Álvarez
- Servicio de Psiquiatría, Hospital 12 de Octubre (imas12), Madrid, Spain.,Instituto de Investigación, Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Julia Sevilla-Llewellyn-Jones
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, Spain.,Instituto de Investigación (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Agüera-Ortiz
- Servicio de Psiquiatría, Hospital 12 de Octubre (imas12), Madrid, Spain.,Instituto de Investigación, Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, Ministry of Science and Innovation, Madrid, Spain.,Departamento de Medicina Legal, Psiquiatría y Patología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Weiler CR, Austen KF, Akin C, Barkoff MS, Bernstein JA, Bonadonna P, Butterfield JH, Carter M, Fox CC, Maitland A, Pongdee T, Mustafa SS, Ravi A, Tobin MC, Vliagoftis H, Schwartz LB. AAAAI Mast Cell Disorders Committee Work Group Report: Mast cell activation syndrome (MCAS) diagnosis and management. J Allergy Clin Immunol 2019; 144:883-896. [DOI: 10.1016/j.jaci.2019.08.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/18/2022]
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Association between anticholinergic (atropinic) drug exposure and cognitive function in longitudinal studies among individuals over 50 years old: a systematic review. Eur J Clin Pharmacol 2019; 75:1631-1644. [DOI: 10.1007/s00228-019-02744-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/09/2019] [Indexed: 12/19/2022]
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Pazan F, Burkhardt H, Frohnhofen H, Weiss C, Throm C, Kuhn-Thiel A, Wehling M. Higher Fit-fOR-The-Aged (FORTA) Scores Comprising Medication Errors are Associated with Impaired Cognitive and Physical Function Tests in the VALFORTA Trial. Drugs Aging 2019; 36:269-277. [PMID: 30578459 DOI: 10.1007/s40266-018-0626-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The Fit fOR The Aged (FORTA) list, a drug classification combining positive and negative labelling of drugs, has been clinically (VALFORTA-trial) validated to improve medication quality and clinical endpoints. OBJECTIVE The objective of this study was to determine the association of medication quality with functional abilities tested in cognitive and physical function tests. PATIENTS AND METHODS Data from the prospective, randomized controlled VALFORTA trial on 409 geriatric (mean age 81.53 years) in-hospital patients were tested for associations between the FORTA score (sum of over- and under-treatment errors) on admission and cognitive and physical function tests. Univariate and multivariate linear correlations corrected for age, sex, number of medications, number of chronic conditions, and body mass index as well as comparisons between high and low FORTA-score (cut-off 3) patients were performed. RESULTS The FORTA score was significantly correlated with Instrumental Activities of Daily Living (p < 0.0001), the Tinetti test (p < 0.002), Essen Questionnaire on Age and Sleepiness (p < 0.0001), Mini-Mental State Examination (p < 0.0001), and handgrip strength (p < 0.04) in the univariate analysis, and with Instrumental Activities of Daily Living (p < 0.003), the Tinetti test (p < 0.003), and the Essen Questionnaire on Age and Sleepiness (p < 0.0001) in the multivariate analysis. Effect size was weak for Instrumental Activities of Daily Living (R-squared = 0.12) and the Tinetti test (R-squared = 0.03) and medium for the Essen Questionnaire on Age and Sleepiness (R-squared = 0.22). Significant differences between patients with high and low FORTA scores were found for Instrumental Activities of Daily Living, the Tinetti test, mini-nutritional assessments, Mini-Mental State Examination, Essen Questionnaire on Age and Sleepiness, and the Geriatric Depression Scale. All significant tests revealed that higher FORTA scores (lower medication quality) were associated with less favorable test outcomes. CONCLUSIONS The FORTA score is associated with relevant aspects of comprehensive geriatric assessment, underlining the importance of medication quality for the functional and cognitive well-being of older patients. TRIAL REGISTRATION NUMBER DRKS00000531.
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Affiliation(s)
- Farhad Pazan
- Medical Faculty Mannheim, Institute for Clinical Pharmacology, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Heinrich Burkhardt
- IV. Medical Department, Geriatrics, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Helmut Frohnhofen
- Department of Medicine, Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Christel Weiss
- Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christina Throm
- Department of Cardiology and Angiology, Agaplesion Markus Hospital, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Germany
| | | | - Martin Wehling
- Medical Faculty Mannheim, Institute for Clinical Pharmacology, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Andre L, Gallini A, Montastruc F, Coley N, Montastruc JL, Vellas B, Andrieu S, Gardette V. Anticholinergic exposure and cognitive decline in older adults: effect of anticholinergic exposure definitions in a 3-year analysis of the multidomain Alzheimer preventive trial (MAPT) study. Br J Clin Pharmacol 2018; 85:71-99. [PMID: 30098049 DOI: 10.1111/bcp.13734] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 06/19/2018] [Accepted: 07/27/2018] [Indexed: 01/02/2023] Open
Abstract
AIM The aim of the present study was to assess the association between anticholinergic (atropinic) burden and cognitive decline in older adults over the course of 3 years. METHODS We used data from Multidomain Alzheimer Preventive Trial (MAPT) study participants aged ≥70 years and at risk of cognitive decline. Cognitive function was assessed with a composite score [Mini-Mental State Examination (MMSE) orientation, Free and Cued Selective Reminding Test, Category Naming Test, Digit Symbol Substitution Test] at 12, 24 and 36 months. Participants declining by more than 0.236 points on the composite score (representing the lowest quintile of 1-year cognitive change) during any 1-year period were considered to have undergone cognitive decline. Anticholinergic exposure was defined by four methods for each of four anticholinergic scales (Anticholinergic Drug Scale, Anticholinergic Cognitive Burden, Anticholinergic Risk Scale, the Durán list). The association between cognitive decline and time-varying anticholinergic exposure [primary analysis using the Durán list and maximal anticholinergic score (0, 1 or 3)] was assessed using Cox proportional hazards models. Other cognitive decline definitions were used in sensitivity analyses. RESULTS At baseline, among 1396 patients included, 7.4-23.5% were exposed to anticholinergic agents, depending on the anticholinergic scale used. Sixty-four per cent of participants experienced cognitive decline during follow-up. Regardless of the anticholinergic scale/exposure measurement used, no significant association was observed with cognitive decline {primary analysis: compared with non-anticholinergic agent users, hazard ratio [HR] = 1.14 [95% confidence interval (CI) = 0.95, 1.38] for anticholinergic score = 1; HR = 0.92 [95% CI = 0.65, 1.30] for score = 3}. Results were stable in sensitivity analyses. CONCLUSION We found no significant association between anticholinergic exposure and cognitive decline in older adults using anticholinergic scales and definitions of exposure.
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Affiliation(s)
- Laurine Andre
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France.,Service d'Epidémiologie, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - Adeline Gallini
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Service d'Epidémiologie, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - François Montastruc
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire, Faculté de Médecine, Toulouse, France
| | - Nicola Coley
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Service d'Epidémiologie, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - Jean-Louis Montastruc
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire, Faculté de Médecine, Toulouse, France
| | - Bruno Vellas
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - Sandrine Andrieu
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Service d'Epidémiologie, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - Virginie Gardette
- UMR INSERM 1027, Université de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), France.,Service d'Epidémiologie, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
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Sevilla-Sánchez D, Molist-Brunet N, González-Bueno J, Solà-Bonada N, Espaulella-Panicot J, Codina-Jané C. Prevalence, risk factors and adverse outcomes of anticholinergic burden in patients with advanced chronic conditions at hospital admission. Geriatr Gerontol Int 2018; 18:1159-1165. [DOI: 10.1111/ggi.13330] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 02/14/2018] [Accepted: 03/07/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Daniel Sevilla-Sánchez
- Pharmacy Department, Vic University Hospital - Vic Hospital Consortium; Hospital of Santa Creu of Vic (Barcelona); Spain
| | - Núria Molist-Brunet
- Acute Geriatric Unit, Vic University Hospital, Hospital of Santa Creu of Vic (Barcelona); Spain
| | - Javier González-Bueno
- Pharmacy Department, Vic University Hospital - Vic Hospital Consortium; Hospital of Santa Creu of Vic (Barcelona); Spain
| | - Núria Solà-Bonada
- Pharmacy Department, Vic University Hospital - Vic Hospital Consortium; Hospital of Santa Creu of Vic (Barcelona); Spain
| | - Joan Espaulella-Panicot
- Acute Geriatric Unit, Vic University Hospital, Hospital of Santa Creu of Vic (Barcelona); Spain
- Geriatric and Palliative Care Territorial Unit, Hospital of Santa Creu of Vic, Vic Hospital Consortium (Barcelona); Spain
| | - Carles Codina-Jané
- Pharmacy Department, Vic University Hospital - Vic Hospital Consortium; Hospital of Santa Creu of Vic (Barcelona); Spain
- Pharmacy Department. Hospital Clinic of Barcelona, Barcelona; Spain
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