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Hook A, Randall JL, Grubb CM, Ellis N, Wellington J, Hemmad A, Zerdelis A, Winnett ARD, Geers BDW, Sykes B, Auty CN, Vinchenzo C, Thorburn CE, Asogbon D, Granger E, Boagey H, Raphael J, Patel K, Bhargava K, Dolley MKM, Maden MJ, Shah MM, Lee QM, Vaidya R, Sehdev S, Barai S, Roche S, Khalid U, Codling DA, Harrison JR. Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study. BMC Geriatr 2022; 22:783. [PMID: 36203156 PMCID: PMC9541078 DOI: 10.1186/s12877-022-03235-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 05/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background Anticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission. Methods We included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient’s medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon’s rank test was used to look at the correlation between two subgroups upon admission and discharge. Results On admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant (p = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications. Conclusions Our cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03235-9.
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Affiliation(s)
- Annabelle Hook
- Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK. .,Great Western Hospital, Marlborough Road, Swindon, SN3 6BB, UK.
| | - Jessica L Randall
- Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Carla M Grubb
- Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK.,Betsi Cadwaladr University Health Board, Bangor, LL57 2PW, UK
| | - Natalie Ellis
- Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK.,Withybush Hospital, Fishguard Road, Haverfordwest, SA61 2PZ, UK
| | - Jack Wellington
- Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Aayushi Hemmad
- The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Agisilaos Zerdelis
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.,University Hospital of Wales, Heath Park Way, Cardiff, CF14 4XW, UK
| | - Andrew R D Winnett
- Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London, EN11 1NR, UK
| | | | - Bethany Sykes
- University of Exeter Medical School, Heavitree Road, Exeter, EX1 2LU, UK
| | - Charlotte N Auty
- School of Medicine, University of Manchester, Manchester, M13 9PL, UK.,Queen's Medical Centre Nottingham, Clifton Boulevard, Derby Road, Nottingham, NG7 2UH, UK
| | - Cecilia Vinchenzo
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Furness Building, Lancaster, LA1 4YG, UK
| | - Christiane E Thorburn
- Bristol Medical School, University of Bristol, First Floor, 5 Tyndall Avenue, Bristol, BS8 1UD, UK
| | - Daniella Asogbon
- Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Emily Granger
- University Hospitals of Morecambe Bay NHS Foundation Trust, Burton Road, Kendal, LA9 7RG, UK.,Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Fulwood, Preston, Lancashire, PR2 9HT, UK
| | - Heather Boagey
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Juliet Raphael
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK
| | - Kajal Patel
- School of Medicine, University of Manchester, Manchester, M13 9PL, UK
| | - Kartik Bhargava
- The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Mary-Kate M Dolley
- Peninsula Medical School, The Faculty of Medicine and Dentistry, The John Bull Building, Plymouth Science Park, Research Way, Plymouth, PL6 8BU, UK
| | - Matthew J Maden
- School of Medicine, University of Manchester, Manchester, M13 9PL, UK
| | - Mehdin M Shah
- Bart's and The London School of Medicine and Dentistry, Queen Mary's University of London, Garrod Building, Turner Street, Whitechapel, London, E1 2AD, UK
| | - Qao M Lee
- Bart's and The London School of Medicine and Dentistry, Queen Mary's University of London, Garrod Building, Turner Street, Whitechapel, London, E1 2AD, UK
| | - Ratnaraj Vaidya
- The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Simran Sehdev
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Sneha Barai
- School of Clinical Medicine, University of Cambridge, Box 111, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK.,Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough, PE3 9GZ, UK
| | - Sophie Roche
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Uzair Khalid
- University College London Medical School, 74 Huntley St, Bloomsbury, London, WC1E 6DE, UK.,St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - David A Codling
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Judith R Harrison
- Biomedical Research Building Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Maindy Road, Cardiff, CF24 4HQ, UK
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Randall J, Hook A, Grubb CM, Ellis N, Wellington J, Hemmad A, Zerdelis A, Geers B, Sykes B, Auty C, Vinchenzo C, Thorburn C, Asogbon D, Granger E, Boagey H, Raphael J, Patel K, Bhargava K, Dolley MK, Maden M, Shah M, Lee Q, Vaidya R, Sehdev S, Barai S, Roche S, Khalid U, Harrison J, Codling D. Dementia patients have greater anti-cholinergic drug burden on discharge from hospital: A multicentre cross-sectional study. Eur Psychiatry 2021. [PMCID: PMC9476103 DOI: 10.1192/j.eurpsy.2021.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionAnticholinergic medications block cholinergic transmission. The central effects of anticholinergic drugs can be particularly marked in patients with dementia. Furthermore, anticholinergics antagonise the effects of cholinesterase inhibitors, the main dementia treatment.ObjectivesThis study aimed to assess anticholinergic drug prescribing among dementia patients before and after admission to UK acute hospitals.Methods352 patients with dementia were included from 17 hospitals in the UK. All were admitted to surgical, medical or Care of the Elderly wards in 2019. Information about patients’ prescriptions were recorded on a standardised form. An evidence-based online calculator was used to calculate the anticholinergic drug burden of each patient. The correlation between two subgroups upon admission and discharge was tested with Spearman’s Rank Correlation.ResultsTable 1 shows patient demographics. On admission, 37.8% of patients had an anticholinergic burden score ≥1 and 5.68% ≥3. At discharge, 43.2% of patients had an anticholinergic burden score ≥1 and 9.1% ≥3. The increase was statistically significant (rho 0.688; p=2.2x10-16). The most common group of anticholinergic medications prescribed at discharge were psychotropics (see Figure 1). Among patients prescribed cholinesterase inhibitors, 44.9% were also taking anticholinergic medications.ConclusionsThis multicentre cross-sectional study found that people with dementia are frequently prescribed anticholinergic drugs, even if also taking cholinesterase inhibitors, and are significantly more likely to be discharged with a higher anticholinergic drug burden than on admission to hospital.Conflict of interestThis project was planned and executed by the authors on behalf of SPARC (Student Psychiatry Audit and Research Collaborative). We thank the National Student Association of Medical Research for allowing us use of the Enketo platform. Judith Harrison was su
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Jolly JK, Juenemann K, Boagey H, Nadsady M, Bridge H, Maclaren RE. Validation of electronic visual acuity (EVA) measurement against standardised ETDRS charts in patients with visual field loss from inherited retinal degenerations. Br J Ophthalmol 2019; 104:924-931. [PMID: 31585961 DOI: 10.1136/bjophthalmol-2019-315124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/09/2019] [Accepted: 09/15/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND With the increase in clinical trials testing therapy for retinal disease, there is a need to ensure that outcome measures are both accurate and standardised. The US Food and Drug Administration favours the use of visual acuity measured using ETDRS logMAR charts. The loss of visual field can interfere with visual tracking across the charts, leading to increased variability of measurements. Electronic visual acuity (EVA) presents the optotype on the centre of a screen, thereby removing the tracking element of the task, and may provide a more precise measurement. METHODS Visual acuity was measured twice using ETDRS charts, EVA automated single letter (E-ETDRS) and EVA single line (EVA-SL) presentation (EMMES). Patients underwent microperimetry (MAIA; Centervue) to determine visual field. We tested 65 patients with rod-cone dystrophies and 41 healthy volunteers. RESULTS Both participant groups read 2-3 letters more on average on the electronic charts compared with ETDRS. Limits of agreement using a modified Bland-Altman analysis account for replicates were wider in eyes with foveal defects (-9 to 18) compared with eyes without foveal defects (-11 to 15). Electronic charts in the presence of foveal defects reduced the range (-11 to 13). CONCLUSION EVA may provide more accurate measures of visual acuity than traditional ETDRS charts in patients when the visual field loss encroached on the central vision. Electronic presentation with a single line of letters was the favoured style reported by patients and should be considered in future interventional clinical trials.
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Affiliation(s)
- Jasleen K Jolly
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK .,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Kristin Juenemann
- Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Heather Boagey
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Marie Nadsady
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Holly Bridge
- Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Robert E Maclaren
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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