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Chughtai B, Ricker CN, Boldt RJ, Elterman D. Real-world onabotulinumtoxinA treatment patterns in patients with overactive bladder. Neurourol Urodyn 2024; 43:396-406. [PMID: 38149719 DOI: 10.1002/nau.25370] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/31/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Utilization patterns of third-line onabotulinumtoxinA for overactive bladder (OAB) symptoms-including discontinuation and use of other therapeutic options during or after treatment-are not well understood. This retrospective analysis of administrative claims was designed to characterize the unmet need for OAB treatment. MATERIALS AND METHODS A retrospective claims analysis of Optum's deidentified Clinformatics® Data Mart Database (2009-2021) was performed among patients with diagnosis of OAB newly starting onabotulinumtoxinA injection (2015-2017). Study measures were evaluated during an 18-month pretreatment baseline and over a minimum of 36 months of follow-up. These included number of injections, days between injections, other measures of onabotulinumtoxinA utilization, use of second-line pharmacologic treatments, use of device and surgical treatment options, and complications. RESULTS Of 2505 eligible patients, 535 (21.4%; 66.8 ± 13.3 y, 87.3% females) continued onabotulinumtoxinA throughout the study. The remaining 1970 (78.6%; 71.4 ± 11.6 y, 79.1% females) were considered discontinuers. Of continuers, 57% received ≥5 treatments. Of discontinuers, 84% received ≤2 treatments. Anticholinergics and β3-adrenoceptor agonist medication use declined in all patients from baseline to follow-up; however, the absolute reduction in the proportion with any medication fill was similar across continuers versus discontinuers (21% vs. 18%, p < 0.0001). Sacral neuromodulation was initiated by 15/535 (3%) of continuers and 137/1970 (7%) of discontinuers (p < 0.0001). No patients initiated percutaneous tibial neuromodulation. CONCLUSIONS Early discontinuation of onabotulinumtoxinA therapy for OAB is common and most discontinuers do not receive alternative treatments. Providers have the opportunity to educate OAB patients with un- or undertreated symptoms regarding alternative options.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | | | | | - Dean Elterman
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
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Okita Y, Kitamura T, Komukai S, Zha L, Komatsu M, Narii N, Murata F, Megumi M, Gon Y, Kimura Y, Kiyohara K, Sobue T, Fukuda H. Association of anticholinergic drug exposure with the risk of dementia among older adults in Japan: The LIFE Study. Int J Geriatr Psychiatry 2023; 38:e6029. [PMID: 38041399 DOI: 10.1002/gps.6029] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES Several studies have investigated that anticholinergic drugs cause cognitive impairment. However, the risk of dementia associated with anticholinergics has not been extensively investigated in the super-aging society of Japan. We conducted this study to assess the association between anticholinergic drugs and the risk of dementia in older adults in Japan. METHODS This nested case-control study used data from the Longevity Improvement & Fair Evidence Study, which includes claim data in Japan from 2014 to 2020. We included 66,478 cases of diagnosed dementia and 328,919 matched controls aged ≥65 years, matched by age, sex, municipality, and cohort entry year. Primary exposure was the total cumulative anticholinergic drugs prescribed from cohort entry date to event date or matched index date, which was the total standardized daily doses for each patient, calculated by adding the total dose of different types of anticholinergic drugs in each prescription, divided by the World Health Organization-defined daily dose values. Odds ratios for dementia associated with cumulative exposure to anticholinergic drugs were calculated using conditional logistic regression adjusted for confounding variables. RESULTS The mean (standard deviation) age at index date was 84.3 (6.9), and the percentage of women was 62.1%. From cohort entry date to event date or matched index date, 18.8% of the case patients and 13.7% of the controls were prescribed at least one anticholinergic drug. In the multivariable-adjusted model, individuals with anticholinergic drugs prescribed had significantly higher odds of being diagnosed with dementia (adjusted odds ratio, 1.50 [95% confidence interval, 1.47-1.54]). Among specific types of anticholinergic drugs, a significant increase in risk was observed with the use of antidepressants, antiparkinsonian drugs, antipsychotics, and bladder antimuscarinics in a fully multivariable-adjusted model. CONCLUSIONS Several types of anticholinergic drugs used by older adults in Japan are associated with an increased risk of dementia. These findings suggest that the underlying risks should be considered alongside the benefits of prescribing anticholinergic drugs to this population.
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Affiliation(s)
- Yuki Okita
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Sho Komukai
- Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masayo Komatsu
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Nobuhiro Narii
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Fumiko Murata
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Maeda Megumi
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yasufumi Gon
- Department of Neurology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yasuyoshi Kimura
- Department of Neurology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Chiyoda-ku, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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3
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Healy D. The past, present and future of anticholinergic drugs. Ther Adv Psychopharmacol 2023; 13:20451253231176375. [PMID: 37701889 PMCID: PMC10493060 DOI: 10.1177/20451253231176375] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/28/2023] [Indexed: 09/14/2023] Open
Abstract
In current medical practice, it is difficult to find any reports claiming that drugs that are primarily anticholinergic or those that have significant anticholinergic effects have any therapeutic benefits. These drugs fell into disrepute within the mental health field from the mid-1960s onwards, and their supposed problems extended to elsewhere in medicine after that. There is considerable evidence that this disrepute stemmed more from marketing copy rather than from hard clinical trial data. Many apparent reviews appear to repeat prior claims rather than present substantial or new evidence. This article offers a perspective rather than a systematic review as there is little evidence other than claims to review. The aim is to challenge the conventional narrative that anticholinergic effects are uniquely hazardous by pointing to the uncertain basis for claims about the harms of anticholinergic drugs, antimuscarinic drugs in particular, ending with pointers to recent research that, if realized, might underpin important possible future benefits.
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Affiliation(s)
- David Healy
- Data Based Medicine Americas Ltd., 95 Sandringham Drive, Toronto, ON, M3H 1E1 Canada
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Mur J, Marioni RE, Russ TC, Muniz‐Terrera G, Cox SR. Anticholinergic burden in middle and older age is associated with lower cognitive function, but not with brain atrophy. Br J Clin Pharmacol 2023; 89:2224-2235. [PMID: 36813260 PMCID: PMC10953410 DOI: 10.1111/bcp.15698] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
AIMS The aim of this study is to estimate the association between anticholinergic burden, general cognitive ability and various measures of brain structural MRI in relatively healthy middle-aged and older individuals. METHODS In the UK Biobank participants with linked health-care records (n = 163,043, aged 40-71 at baseline), of whom about 17 000 had MRI data available, we calculated the total anticholinergic drug burden according to 15 different anticholinergic scales and due to different classes of drugs. We then used linear regression to explore the associations between anticholinergic burden and various measures of cognition and structural MRI, including general cognitive ability, 9 separate cognitive domains, brain atrophy, volumes of 68 cortical and 14 subcortical areas and fractional anisotropy and median diffusivity of 25 white-matter tracts. RESULTS Anticholinergic burden was modestly associated with poorer cognition across most anticholinergic scales and cognitive tests (7/9 FDR-adjusted significant associations, standardised betas (β) range: -0.039, -0.003). When using the anticholinergic scale exhibiting the strongest association with cognitive functions, anticholinergic burden due to only some classes of drugs exhibited negative associations with cognitive function, with β-lactam antibiotics (β = -0.035, PFDR < 0.001) and opioids (β = -0.026, PFDR < 0.001) exhibiting the strongest effects. Anticholinergic burden was not associated with any measure of brain macrostructure or microstructure (PFDR > 0.08). CONCLUSIONS Anticholinergic burden is weakly associated with poorer cognition, but there is little evidence for associations with brain structure. Future studies might focus more broadly on polypharmacy or more narrowly on distinct drug classes, instead of using purported anticholinergic action to study the effects of drugs on cognitive ability.
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Affiliation(s)
- Jure Mur
- Lothian Birth Cohorts Group, Department of PsychologyUniversity of EdinburghEdinburghUK
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUK
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
| | - Riccardo E. Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUK
| | - Tom C. Russ
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
- Edinburgh Dementia PreventionUniversity of EdinburghEdinburghUK
- Division of Psychiatry, Centre for Clinical Brain ScienceUniversity of EdinburghEdinburghUK
| | - Graciela Muniz‐Terrera
- Edinburgh Dementia PreventionUniversity of EdinburghEdinburghUK
- Department of Social MedicineOhio UniversityAthensOhioUSA
| | - Simon R. Cox
- Lothian Birth Cohorts Group, Department of PsychologyUniversity of EdinburghEdinburghUK
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Malkiewicz JJ, Kasprzyk AG, Waksmundzki D, Węgrzynek J, Chmiela T, Siuda J. Risk factors for dementia in Parkinson's Disease - the overuse of anticholinergic drugs. Neurol Neurochir Pol 2023; 57:405-413. [PMID: 37357543 DOI: 10.5603/pjnns.a2023.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/27/2023]
Abstract
AIM OF THE STUDY To determine the risk factors for dementia in a group of patients with Parkinson's Disease (PD), especially the effect of the anticholinergic burden assessed according to the Anticholinergic Cognitive Burden scale (ACB) and the CRIDECO Anticholinergic Load Scale (CALS). CLINICAL RATIONALE FOR THE STUDY To provide information about factors associated with Parkinson's Disease dementia (PDD), especially the anticholinergic burden and testing the effect of both scales in an assessment of the anticholinergic burden in this group of patients. MATERIAL AND METHODS A retrospective and cross-sectional analysis of medical records of patients with Parkinson's Disease admitted to the Neurology Department of the Medical University of Silesia, Katowice, Poland between 2019 and 2021 was performed. We found 418 patients with a diagnosis of PD, but 80 were excluded due to lack of a cognitive function assessment. Based on MMSE score, the remaining 338 patients were divided into two groups of patients with, and without, PDD. Next, demographic and clinical data was collected. The anticholinergic burden was assessed using the ACB and the CALS scales. According to the authors of these scales, : if a scale score is of three or more points, this should be considered as a significant anticholinergic burden. Multiple logistic regression with backward elimination was used to assess factors significantly related to the presence of dementia, and two different models were used for both scales assessing the anticholinergic burden. RESULTS 62 (18.3%) patients were diagnosed with PDD. Overall significant anticholinergic burden (≥ 3 points) was found in 31.95% of patients using CALS and in 18.93% using ACB. Anticholinergic burden was higher in patients with dementia (CALS 50 vs. 27.90%, p < 0.001, ACB 43.5 vs. 13.41%, p < 0.001). According to both models, the factors significantly related to dementia were: age (ACB OR 1,114 (1.062-1.170), p < 0.001, CALS OR 1.123 (1.070-1.178), p < 0.001), significant anticholinergic burden (ACB OR 3.433 (1.746-6.750), p < 0.001, CALS OR 2.166 (1.157-4.055), p = 0.016) disease severity in the Hoehn-Yahr scale (ACB OR 1.752 (1.197-2.565), p = 0.004, CALS OR 1.831 (1.256-2.670), p = 0.002) and atrial fibrillation (ACB OR 5.593 (1.417-22.083), p = 0.014, CALS OR 5.159 (1.314-20.254), p = 0.016). CONCLUSIONS AND CLINICAL IMPLICATIONS The anticholinergic burden is larger in PDD patients compared to PD patients without dementia. CALS or ACB scales are helpful in this risk assessment and might be crucial to avoid the development of PDD, especially in older PD patients with multimorbidities.
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Affiliation(s)
- Jakub J Malkiewicz
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Amadeusz G Kasprzyk
- Students' Scientific Association, Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Damian Waksmundzki
- Students' Scientific Association, Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Julia Węgrzynek
- Students' Scientific Association, Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Tomasz Chmiela
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Joanna Siuda
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
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Balasundaram B, Ang WST, Stewart R, Bishara D, Ooi CH, Li F, Akram F, Eu Kwek AB. Improving quantification of anticholinergic burden using the Anticholinergic Effect on Cognition Scale - a healthcare improvement study in a geriatric ward setting. Australas Psychiatry 2022; 30:535-540. [PMID: 35726508 PMCID: PMC9379386 DOI: 10.1177/10398562221103117] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Anticholinergic burden refers to the cumulative effects of taking multiple medications with anticholinergic effects. This study was carried out in a public hospital in Singapore, aimed to improve and achieve a 100% comprehensive identification and review of measured, anticholinergic burden in a geriatric psychiatry liaison service to geriatric wards. We evaluated changes in pre-to post-assessment anticholinergic burden scores and trainee feedback. METHOD Plan Do Study Act methodology was employed, and Anticholinergic Effect on Cognition scale (AEC) was implemented as the study intervention. A survey instrument evaluated trainee feedback. RESULTS There was no measured anticholinergic burden in a baseline of 170 assessments. 75 liaison psychiatry assessments were conducted between June and November 2021 in two cycles. 94.7% of pre-assessments (at the time of assessment) and 71.1% of post-assessments (following assessment) had a record of AEC scores in clinical documentation in cycle one, improving in the second cycle to 100%, 94.6%, respectively. A high post-assessment AEC score of 3 and over reduced from 15.8% in cycle one to 5.4% in cycle two. The trainee feedback suggested an enriching educational experience. CONCLUSIONS Using the AEC scale, the findings support the feasibility of comprehensive identification and review of measured anticholinergic burden in older people with neurocognitive disorders.
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Affiliation(s)
| | | | - Robert Stewart
- Department of Psychological Medicine, 34426Kings College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Delia Bishara
- Department of Psychological Medicine, Kings College London, Institute of Psychiatry, Psychology and Neuroscience, Mental Health of Older Adults & Dementia, 4958South London & Maudsley NHS Foundation Trust, London, UK
| | - Chun How Ooi
- Department of Geriatric Medicine, 26674Changi General Hospital, Singapore
| | - Fuyin Li
- Advanced Practice Nurse Development, Department of Nursing, 26674Changi General Hospital, Singapore
| | - Farooq Akram
- Department of Internal Medicine, 26674Changi General Hospital, Singapore
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Alomari MS, Abdulhamid AS, Ghaddaf AA, Alshareef KM, Haneef AK, AlQuhaibi MS, Banjar RA. Non-inferior and more feasible transcutaneous tibial nerve stimulation in treating overactive bladder: A systematic review and meta-analysis. Int J Urol 2022; 29:1170-1180. [PMID: 35711082 DOI: 10.1111/iju.14961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/09/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Overactive bladder (OAB) is identified as a urinary urgency accompanied by frequency and nocturia with or without urgency urinary incontinence in the nonexistence of a urinary tract infection or other evident pathologies. This systematic review and meta-analysis aimed to evaluate the efficacy of the transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) or anticholinergic drugs in reducing symptoms and improving the quality of life for OAB patients. METHODS We performed a systematic search in Medline, Embase, and CENTRAL, in which we included randomized controlled trials that compared TTNS with anticholinergic drugs or PTNS in treating idiopathic OAB. We evaluated the following outcomes: 3-day voiding diary (voiding frequency/day, daytime micturition frequency/day, nighttime micturition frequency/day, number of urgency episodes/day, number of incontinence episodes/day, and mean voiding volume), symptom bother, health related quality of life (HRQoL), and adverse events. We used 95% as a confidence interval (CI) and p < 0.05. Standardized mean difference (SMD) was used for continuous outcomes, and the risk ratio (RR) was used for dichotomous outcomes. RESULTS There was no significant difference comparing TTNS with anticholinergic drugs or PTNS regarding voiding frequency/day (SMD = -0.01, 95% CI -0.33 to 0.32), nighttime micturition frequency/day (SMD = -0.28, 95% CI -0.94 to 0.37), number of urgency episodes/day (SMD = -0.05, 95% CI -0.36 to 0.26), number of incontinence episodes/day (SMD = -0.04, 95% CI -0.32 to 0.25), symptom bother (SMD = -0.19, 95% CI -0.55 to 0.16), HRQoL (SMD = 0.27, 95% CI -0.32 to 0.85), and adverse events (RR = 0.07, 95% CI 0.01 to 0.54). CONCLUSION The current meta-analysis reveals that there is no statistically significant difference between TTNS versus PTNS or anticholinergic drugs for the nonsurgical management of OAB patients.
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Affiliation(s)
- Mohammed S Alomari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed S Abdulhamid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah A Ghaddaf
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Khalid M Alshareef
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed K Haneef
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mohammad S AlQuhaibi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Rowaa A Banjar
- Department of Urology, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
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8
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Mur J, Russ TC, Cox SR, Marioni RE, Muniz‐Terrera G. Association between anticholinergic burden and dementia in UK Biobank. Alzheimers Dement (N Y) 2022; 8:e12290. [PMID: 35434252 PMCID: PMC9005668 DOI: 10.1002/trc2.12290] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/11/2022] [Accepted: 03/03/2022] [Indexed: 11/20/2022]
Abstract
Background Previous studies on the relationship between anticholinergic drugs and dementia have reported heterogeneous results. This variability could be due to different anticholinergic scales and differential effects of distinct classes of drugs. Methods Using Cox proportional hazards models, we computed the association between annual anticholinergic burden (AChB) and the risk of dementia in UK Biobank with linked general practitioner prescription records between the years 2000 and 2015 (n = 171,775). Results AChB according to most anticholinergic scales (standardized odds ratio range: 1.027-1.125) and the slope of the AChB trajectory (hazard ratio = 1.094; 95% confidence interval: 1.068-1.119) were predictive of dementia. However, the association between AChB and dementia held only for some classes of drugs, especially antidepressants, antiepileptics, and antidiuretics. Discussion The heterogeneity in previous findings may partially be due to different effects for different classes of drugs. Future studies should establish differences in more detail and further examine the practicality of a general measure of AChB relating to the risk of dementia.
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Affiliation(s)
- Jure Mur
- Lothian Birth Cohorts GroupDepartment of PsychologyUniversity of EdinburghEdinburghUK
- Centre for Genomic and Experimental MedicineInstitute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUK
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
| | - Tom C. Russ
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
- Edinburgh Dementia PreventionUniversity of EdinburghEdinburghUK
- Division of PsychiatryCentre for Clinical Brain ScienceUniversity of EdinburghEdinburghUK
| | - Simon R. Cox
- Lothian Birth Cohorts GroupDepartment of PsychologyUniversity of EdinburghEdinburghUK
| | - Riccardo E. Marioni
- Centre for Genomic and Experimental MedicineInstitute of Genetics and CancerUniversity of EdinburghEdinburghUK
| | - Graciela Muniz‐Terrera
- Edinburgh Dementia PreventionUniversity of EdinburghEdinburghUK
- Division of PsychiatryCentre for Clinical Brain ScienceUniversity of EdinburghEdinburghUK
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9
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Meng D, Mohammadi-Nejad AR, Sotiropoulos SN, Auer DP. Anticholinergic drugs and forebrain magnetic resonance imaging changes in cognitively normal people and those with mild cognitive impairment. Eur J Neurol 2022; 29:1344-1353. [PMID: 35129272 PMCID: PMC9304308 DOI: 10.1111/ene.15251] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/13/2022] [Indexed: 01/24/2023]
Abstract
Background and purpose Anticholinergic (AC) medication use is associated with cognitive decline and dementia, which may be related to an AC‐induced central hypocholinergic state, but the exact mechanisms remain to be understood. We aimed to further elucidate the putative link between AC drug prescription, cognition, and structural and functional impairment of the forebrain cholinergic nucleus basalis of Meynert (NBM). Methods Cognitively normal (CN; n = 344) and mildly cognitively impaired (MCI; n = 224) Alzheimer’s Disease Neuroimaging Initiative Phase 3 participants with good quality 3‐T magnetic resonance imaging were included. Structural (regional gray matter [GM] density) and functional NBM integrity (functional connectivity [FC]) were compared between those on AC medication for > 1 year (AC+) and those without (AC−) in each condition. AC burden was classed as mild, moderate, or severe. Results MCI AC+ participants (0.55 ± 0.03) showed lower NBM GM density compared to MCI AC− participants (0.56 ± 0.03, p = 0.002), but there was no structural AC effect in CN. NBM FC was lower in CN AC+ versus CN AC− (3.6 ± 0.5 vs. 3.9 ± 0.6, p = 0.001), and in MCI AC+ versus MCI AC− (3.3 ± 0.2 vs. 3.7 ± 0.5, p < 0.001), with larger effect size in MCI. NBM FC partially mediated the association between AC medication burden and cognition. Conclusions Our findings provide novel support for a detrimental effect of mild AC medication on the forebrain cholinergic system characterized as functional central hypocholinergic that partially mediated AC‐related cognitive impairment. Moreover, structural tissue damage suggests neurodegeneration, and larger effect sizes in MCI point to enhanced susceptibility for AC medication in those at risk of dementia.
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Affiliation(s)
- Dewen Meng
- Radiological Sciences, Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Ali-Reza Mohammadi-Nejad
- Radiological Sciences, Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Stamatios N Sotiropoulos
- Radiological Sciences, Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Dorothee P Auer
- Radiological Sciences, Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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10
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Hori H, Yasui-Furukori N, Hasegawa N, Iga JI, Ochi S, Ichihashi K, Furihata R, Kyo Y, Takaesu Y, Tsuboi T, Kodaka F, Onitsuka T, Okada T, Murata A, Kashiwagi H, Iida H, Hashimoto N, Ohi K, Yamada H, Ogasawara K, Yasuda Y, Muraoka H, Usami M, Numata S, Takeshima M, Yamagata H, Nagasawa T, Tagata H, Makinodan M, Kido M, Katsumoto E, Komatsu H, Matsumoto J, Kubota C, Miura K, Hishimoto A, Watanabe K, Inada K, Kawasaki H, Hashimoto R. Prescription of Anticholinergic Drugs in Patients With Schizophrenia: Analysis of Antipsychotic Prescription Patterns and Hospital Characteristics. Front Psychiatry 2022; 13:823826. [PMID: 35656353 PMCID: PMC9152135 DOI: 10.3389/fpsyt.2022.823826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
In several clinical guidelines for schizophrenia, long-term use of anticholinergic drugs is not recommended. We investigated the characteristics of the use of anticholinergics in patients with schizophrenia by considering psychotropic prescription patterns and differences among hospitals. A cross-sectional, retrospective prescription survey at the time of discharge was conducted on 2027 patients with schizophrenia from 69 Japanese hospitals. We examined the relations among psychotropic drug prescriptions regarding anticholinergic prescription. We divided the hospitals into three groups-low rate group (LG), medium rate group (MG), and high rate group (HG)-according to their anticholinergic prescription rates, and analyzed the relationship between anticholinergic prescription rates and antipsychotic prescription. Anticholinergic drugs were prescribed to 618 patients (30.5%), and the prescription rates were significantly higher for high antipsychotic doses, antipsychotic polypharmacy, and first-generation antipsychotics (FGAs) use. The anticholinergic prescription rate varied considerably among hospitals, ranging from 0 to 66.7%, and it was significantly higher in patients with antipsychotic monotherapy, antipsychotic polypharmacy, and normal and high doses of antipsychotics in HG than in those LG and MG. The anticholinergics prescription rate in patients with second-generation antipsychotic monotherapy in HG was also significantly higher than in those LG and MG; however, the difference was no longer significant in patients with FGA monotherapy. Conclusively, in addition to high antipsychotic doses, antipsychotic polypharmacy, and FGA use, hospital characteristics influence the prescribing of anticholinergic drugs.
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Affiliation(s)
- Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Naomi Hasegawa
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Jun-Ichi Iga
- Department of Neuropsychiatry Molecules and Function, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Shinichiro Ochi
- Department of Neuropsychiatry Molecules and Function, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Kayo Ichihashi
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Ryuji Furihata
- Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan
| | - Yoshitaka Kyo
- Department of Psychiatry, School of Medicine, Kitasato University, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan
| | - Fumitoshi Kodaka
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiaki Onitsuka
- Department of Neuroimaging Psychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tsuyoshi Okada
- Department of Psychiatry, Jichi Medical University, Tochigi, Japan
| | - Atsunobu Murata
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Hiroko Kashiwagi
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Kodaira, Japan
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hisashi Yamada
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuyoshi Ogasawara
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Nagoya, Japan
| | - Yuka Yasuda
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Life Grow Brilliant Mental Clinic, Medical Corporation Foster, Osaka, Japan
| | - Hiroyuki Muraoka
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Hirotaka Yamagata
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Tatsuya Nagasawa
- Department of Neuropsychiatry, Kanazawa Medical University, Uchinada, Japan
| | - Hiromi Tagata
- Department of Neuropsychiatry, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Mikio Kido
- Toyama City Hospital, Toyama, Japan.,Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | | | - Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Junya Matsumoto
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Chika Kubota
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Kodaira, Japan
| | - Kenichiro Miura
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroaki Kawasaki
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryota Hashimoto
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
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11
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Abstract
There is a link between oral health and systemic health. Conditions such as dementia and pneumonia are associated with poor oral health. Frail older people receive regular care from medical and nursing staff but tend not to see dentists regularly or only seek treatment when there is a dental problem. Collaboration between dentists and other health professionals is therefore increasingly important. Oral health should be assessed regularly. This enables early referral to a dentist. Anticholinergic drugs, particularly in polypharmacy, can have a profound deleterious effect on salivary function and oral health. A medication review may enable the anticholinergic burden to be reduced. In addition to regular brushing, oral preventive products may be appropriate in frail older people.
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Affiliation(s)
- Alan Deutsch
- Bondi Junction Dental Centre, Sydney.,Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Sydney.,Faculty of Medicine and Health, University of Sydney
| | - Emma Jay
- Bondi Junction Dental Centre, Sydney.,Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Sydney.,Faculty of Medicine and Health, University of Sydney
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12
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Mur J, Cox SR, Marioni RE, Muniz-Terrera G, Russ TC. Increase in anticholinergic burden from 1990 to 2015: Age-period-cohort analysis in UK biobank. Br J Clin Pharmacol 2021; 88:983-993. [PMID: 34409635 DOI: 10.1111/bcp.15045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/29/2021] [Revised: 06/28/2021] [Accepted: 08/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The use of prescription drugs with anticholinergic properties has been associated with multiple negative health outcomes in older people. Moreover, recent evidence suggests that associated adverse effects may occur even decades after stopping anticholinergic use. Despite the implicated importance of examining longitudinal patterns of anticholinergic prescribing for different age groups, few such data are available. METHODS We performed an age-period-cohort (APC) analysis to study trends in an aggregate measure of anticholinergic burden between the years 1990 and 2015, utilising data from >220 000 UK Biobank participants with linked prescription data from primary care. RESULTS Anticholinergic burden in the sample increased up to 9-fold over 25 years and was observed for both period and age effects across most classes of drugs. The greatest increase was seen in the prescribing of antidepressants. Female sex, lower education and greater deprivation were associated with greater anticholinergic burden. CONCLUSIONS The increase in anticholinergic prescribing is mostly due to an increase in polypharmacy and is attributable to both ageing of participants and period-related changes in prescribing practices. Research is needed to clarify the implications of rising anticholinergic use for public health and to contextualise this rise in light of other relevant prescribing practices.
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Affiliation(s)
- Jure Mur
- Lothian Birth Cohorts Group, Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Simon R Cox
- Lothian Birth Cohorts Group, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Riccardo E Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK
| | - Tom C Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK
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13
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Paz RM, Murer MG. Mechanisms of Antiparkinsonian Anticholinergic Therapy Revisited. Neuroscience 2021; 467:201-17. [PMID: 34048797 DOI: 10.1016/j.neuroscience.2021.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 01/15/2023]
Abstract
Before the advent of L-DOPA, the gold standard symptomatic therapy for Parkinson's disease (PD), anticholinergic drugs (muscarinic receptor antagonists) were the preferred antiparkinsonian therapy, but their unwanted side effects associated with impaired extrastriatal cholinergic function limited their clinical utility. Since most patients treated with L-DOPA also develop unwanted side effects such as L-DOPA-induced dyskinesia (LID), better therapies are needed. Recent studies in animal models demonstrate that optogenetic and chemogenetic manipulation of striatal cholinergic interneurons (SCIN), the main source of striatal acetylcholine, modulate parkinsonism and LID, suggesting that restoring SCIN function might serve as a therapeutic option that avoids extrastriatal anticholinergics' side effects. However, it is still unclear how the altered SCIN activity in PD and LID affects the striatal circuit, whereas the mechanisms of action of anticholinergic drugs are still not fully understood. Recent animal model studies showing that SCINs undergo profound changes in their tonic discharge pattern after chronic L-DOPA administration call for a reexamination of classical views of how SCINs contribute to PD symptoms and LID. Here, we review the recent advances on the circuit implications of aberrant striatal cholinergic signaling in PD and LID in an effort to provide a comprehensive framework to understand the effects of anticholinergic drugs and with the aim of shedding light into future perspectives of cholinergic circuit-based therapies.
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14
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Rodríguez-Ramallo H, Báez-Gutiérrez N, Prado-Mel E, Alfaro-Lara ER, Santos-Ramos B, Sánchez-Fidalgo S. Association between Anticholinergic Burden and Constipation: A Systematic Review. Healthcare (Basel) 2021; 9:healthcare9050581. [PMID: 34068348 PMCID: PMC8153334 DOI: 10.3390/healthcare9050581] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
The association between anticholinergic burden and constipation is not well defined and documented; for this reason, a systematic review was carried out in five databases (Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus), including studies assessing the correlation between anticholinergic burden, and constipation between January 2006 and December 2020. Data extraction was conducted independently by two researchers. Abstracts and titles were reviewed to determine eligibility for review with eligible articles read in full. From 2507 identified articles, 11 were selected for this review: six cross-sectional studies, four retrospective cohort studies, and a post hoc analysis of a randomized clinical trial. Overall, nine studies reported at least one statistical association between anticholinergic burden and constipation, finding 13 positive results out of 24 association measurements. A total of 211,921 patients were studied. The association between constipation and anticholinergic burden could be demonstrated in studies including 207,795 patients. Most studies were not designed to find differences in constipation prevalence and did not adjust the results by confounding factors. Our findings suggest that a correlation between anticholinergic burden and constipation exists. Higher quality-evidence studies are needed, including analysis that considers confounding factors, such as other non-pharmacological causes of constipation.
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Affiliation(s)
- Héctor Rodríguez-Ramallo
- Pharmacy Department, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain; (H.R.-R.); (N.B.-G.); (E.P.-M.); (B.S.-R.)
| | - Nerea Báez-Gutiérrez
- Pharmacy Department, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain; (H.R.-R.); (N.B.-G.); (E.P.-M.); (B.S.-R.)
| | - Elena Prado-Mel
- Pharmacy Department, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain; (H.R.-R.); (N.B.-G.); (E.P.-M.); (B.S.-R.)
| | - Eva Rocío Alfaro-Lara
- Pharmacy Department, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain; (H.R.-R.); (N.B.-G.); (E.P.-M.); (B.S.-R.)
- Correspondence:
| | - Bernardo Santos-Ramos
- Pharmacy Department, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain; (H.R.-R.); (N.B.-G.); (E.P.-M.); (B.S.-R.)
| | - Susana Sánchez-Fidalgo
- Department of Preventive Medicine and Public Health, Universidad de Sevilla, 41009 Seville, Spain;
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15
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Grill P, Marwick C, De Souza N, Burton JK, Hughes C, Guthrie B. The burden of psychotropic and anticholinergic medicines use in care homes: population-based analysis in 147 care homes. Age Ageing 2021; 50:183-189. [PMID: 32706851 DOI: 10.1093/ageing/afaa122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 02/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND older people living in care-homes are particularly vulnerable to adverse effects of psychotropic and anticholinergic drugs. METHODS anonymised dispensed prescription data from all 4,478 residents aged ≥ 60 years in 147 care-homes in two Scottish health boards were analysed. Psychotropic medicines examined were antipsychotics, antidepressants, hypnotic/anxiolytics, opioids and gabapentinoids. Anticholinergic burden was measured using the modified anticholinergic risk scale (mARS). Variation between care-homes and associations with individual and care-home characteristics were examined using multilevel logistic regression. RESULTS 63.5% of residents were prescribed at least one psychotropic drug, and 27.0% two or more, most commonly antidepressants (41.6%), opioids (20.3%), hypnotic/anxiolytics (16.9%) and antipsychotics (16.7%). 48.1% were prescribed an anticholinergic drug, and 12.1% had high anticholinergic burden (mARS ≥ 3). Variation between care-homes was high for antipsychotics (intra-cluster correlation coefficient [ICC] 8.2%) and hypnotics/anxiolytics (ICC = 7.3%), and moderate for antidepressants (ICC = 4.7%) and anticholinergics (ICC = 2.8%). Prescribing of all drugs was lower in the oldest old. People with dementia were more likely to be prescribed antipsychotics (adjusted OR = 1.45, 95%CI 1.23-1.71) but less likely to be prescribed anticholinergics (aOR = 0.61, 95%CI 0.51-0.74). Prescribing of antipsychotics was higher in Tayside (aOR = 1.52, 95%CI 1.20-1.92), whereas prescribing of antidepressants (particularly tricyclic-related) was lower (aOR = 0.66, 95%CI 0.56-0.79). There was no association with care-home regulator quality scores. CONCLUSION care-home residents have high psychotropic and anticholinergic burden, with considerable variation between care-homes that is not related to existing measures of quality of care. Research to better understand variation between care-homes and the interaction with local prescribing cultures is needed.
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Affiliation(s)
- Paula Grill
- Undergraduate Medical Student, School of Medicine, University of Dundee, Dundee, UK
| | - Charis Marwick
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Nicosha De Souza
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Jennifer Kirsty Burton
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Carmel Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - Bruce Guthrie
- Usher Institute, School of Medicine, University of Edinburgh, Edinburgh, UK
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16
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Jin H, Zhang J, Hu Q, Ping J, Jiang T, Du B, Duan X. Naloxone Alleviate the Severity of Delirium in Hospitalized Patients With Parkinsonism: Three Case Reports. Front Psychiatry 2021; 12:748958. [PMID: 34777052 PMCID: PMC8578847 DOI: 10.3389/fpsyt.2021.748958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Delirium is common in geriatric with Parkinson's disease (PD). Treatments for delirium have generally been neuroleptics; however, antipsychotics have potential effect to block striatal dopamine D2 receptors and worsen symptom of parkinsonism. We explored whether naloxone can alleviate delirium in PD and other forms of parkinsonism. Patients and Methods: Patients with parkinsonism who met the delirium criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) received naloxone infusions once or twice daily. Treatment effects were evaluated by the delirium rating scale-revised 98 (DRS-R98), including non-cognitive and cognitive subscales; the Richmond agitation-sedation scale (RASS); and the mini mental status examination (MMSE). Results: Two patients with primary parkinsonism, one with vascular PD were observed. The daily dose of naloxone was 2.08 ± 0.64 mg (range: 1-4 mg). Medication time last from 1 h to 7 days without side effects observed. Following with naloxone infusions, DRS-R98 scores decreased within 12 h and MMSE scores increased. The psychotic symptoms, disorientation, and attention deficits were alleviated significantly, while RASS scores decreased with naloxone treatment. Conclusion: Naloxone alleviated psychotic symptoms, improved cognitive dysfunction, and irritability in patients with delirium in the context of PD. The preliminary findings point out that the opioid system may be involved in the pathophysiology of delirium, which may be one of potential treat targets for delirium of PD.
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Affiliation(s)
- Haiyan Jin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Department of Psychiatry, The Third People's Hospital of Zhongshan, Zhongshan, China
| | - Qiongyue Hu
- Department of Psychiatry, Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Junjiao Ping
- Department of Psychiatry, The Third People's Hospital of Zhongshan, Zhongshan, China
| | - Tingyun Jiang
- Department of Psychiatry, The Third People's Hospital of Zhongshan, Zhongshan, China
| | - Baoguo Du
- Department of Psychiatry, The Third People's Hospital of Zhongshan, Zhongshan, China
| | - Xin Duan
- Department of Geriatric Psychiatry, Wuzhongpei Memorial Hospital, Foshan, China
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17
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Lee CY, Cheng YD, Cheng WY, Tsai TH, Huang KH. The Prevalence of Anticholinergic Drugs and Correlation with Pneumonia in Elderly Patients: A Population-Based Study in Taiwan. Int J Environ Res Public Health 2020; 17:E6260. [PMID: 32872121 DOI: 10.3390/ijerph17176260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022]
Abstract
Anticholinergic drugs may increase the risk of serious respiratory infection, especially in the elderly. The study aims to investigate the prevalence of anticholinergic drugs and the correlation of incident pneumonia associated with the use of anticholinergic drugs among the elderly in Taiwan. The study population was 275,005 elderly patients aged ≥65 years old, selected from the longitudinal health insurance database (LHID) in 2016. Among all the elderly patients, about 60% had received anticholinergic medication at least once. Furthermore, the study selected elderly patients who had not been diagnosed with pneumonia and had not received any anticholinergic drugs in the past year in order to evaluate the correlation between pneumonia and anticholinergic drugs. The study excluded elderly patients who died or had received related drugs of incident pneumonia during the study period and selected elderly patients receiving anticholinergic drugs as the case group. Propensity score matching (PSM) on a 1:1 scale was used to match elderly patients that were not receiving any anticholinergic drugs as the control group, resulting in a final sample of 32,215 patients receiving anticholinergic drugs and 32,215 patients not receiving any anticholinergic drugs. Conditional logistic regression was used to estimate the association between anticholinergic drugs and pneumonia after controlling for potential confounders. Compared with patients not receiving anticholinergic drugs, the adjusted odds ratio of patients receiving anticholinergic drugs was 1.33 (95% confidence interval: 1.18 to 1.49). Anticholinergic medication is common among elderly patients in Taiwan. Elderly patients receiving anticholinergic drugs may increase their risk of incident pneumonia. The safety of anticholinergic drugs in the elderly should be of concern in Taiwan.
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Chapuis J, Siu-Paredes F, Pavageau C, Amador G, Rude N, Denis F. Anticholinergic Drugs and Oral Health-related Quality of Life in Patients with Schizophrenia: A Pilot Study. Transl Neurosci 2020; 11:10-16. [PMID: 32104590 PMCID: PMC7029653 DOI: 10.1515/tnsci-2020-0003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/16/2020] [Indexed: 12/11/2022] Open
Abstract
Objective The aim of this study was to explore, in a sample population of people with schizophrenia (PWS), the role of the anticholinergic burden on the perception of oral health-related quality of life (OHrQoL) in France. Methods A pilot study was performed between March 2014 and January 2016. PWS were recruited from a population in Côte d’Or department in France. Dental status was investigated using the Decayed, Missing, or Filled Teeth (DMFT) index, the Xerostomia Index (XI), and the Global Oral Health Assessment Index (GOHAI) for OHrQoL. The anticholinergic impregnation score was recorded using the anticholinergic impregnation scale (AIS). Results A sample of 62 people was selected. The DMFT score was 16.5± 8.7, the XI score was 22.9±7.8, the GOHAI score was 43.0±8.8, and the AIS score was 3.1±2.8. In total, 169 drugs were prescribed to the people of our sample, and 114 different anticholinergic drugs were observed. The most frequently used anticholinergic drugs (51.40%), in the study had a low antimuscarinic potency (1 point according to AIS scale). The multiple linear regression model showed that the OHrQoL scores were significantly lower when the DMFT scores, XI score, and anticholinergic scores were high. Conclusions This pilot study highlighted the potential role of the anticholinergic burden on the OHrQoL of PWS. A study with a validated specific scale for the OHrQoL and a standard anticholinergic burden scale should be conducted to clarify the role of anticholinergic drugs on the OHrQoL for PWS.
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Affiliation(s)
- Justine Chapuis
- University Hospital of Tours ,Odontology Department, 37170 Chambray-lès-Tours, France
| | - Francesca Siu-Paredes
- EA 481 Integrative Neurosciences and Clinical. University Hospital of Besançon, 25000 Besançon, France.,Université Champagne Ardenne. Faculté d'odontologie de Reims, 51100 Reims, France
| | - Claire Pavageau
- University Hospital of Tours. Service d'odontologie du CHU de Tours, 37170 Chambray-lès-Tours, France
| | - Gilles Amador
- Université de Nantes, Faculté d'Odontologie de Nantes, 44000 Nantes, France
| | - Nathalie Rude
- EA 481 Integrative Neurosciences and Clinical. University Hospital of Besançon, 25000 Besançon, France
| | - Frédéric Denis
- University Hospital of Tours ,Odontology Department, 37170 Chambray-lès-Tours, France.,Université de Nantes, Faculté d'Odontologie de Nantes, 44000 Nantes, France.,EA 75-05 Education, Ethique, Santé. Université de Tours, Faculté de Médecine, 37032 Tours, France
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19
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Villalba-Moreno AM, Alfaro-Lara ER, Rodríguez-Pérez A, Báñez-Toro D, Sánchez-Fidalgo S, Pérez-Guerrero MC, Santos-Ramos B, Nieto-Martín MD. Association Between Drug Burden Index and Functional and Cognitive Function in Patients with Multimorbidity. Curr Pharm Des 2019; 24:3384-3391. [PMID: 29589542 DOI: 10.2174/1381612824666180327154239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/04/2017] [Revised: 03/11/2018] [Accepted: 03/16/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anticholinergic and sedative drugs are associated with adverse events such as cognitive and functional impairment in elderly. The Drug Burden Index (DBI) is a measure of an individual's total exposure to anticholinergic and sedative drugs. Objetive: The study aimed to evaluate the association between the total DBI and cognitive and functional impairment in patients with multimorbidity. SETTING Patients with multimorbidity enrolled in the IMPACTO project. METHODS Cross-sectional observational study. MAIN OUTCOME MEASURE The anticholinergic and sedative exposure was calculated using DBI. The Pfeiffer Test (PT) was used for cognitive status and the Barthel Index (BI) for functional status. RESULTS 336 patients were included (mean age 77.6 ± 8.7 years, 54.2% men and a mean of 11.5 ± 3.7 prescribed drugs). 180 patients (53.6%) exposed to anticholinergic and/or sedative drugs were identified. The median score obtained in PT was slightly higher in exposed patients (1 (IQR 0-2) and 2 (IQR 0-4), p = 0.082 in "non-exposed" and "exposed", respectively). The bivariate analysis showed an association [0.544 (95% CI 0.044-1.063, p = 0.03)]. The median obtained in the BI analysis was 85.0 (IQR 30.0) and 75.5 (IQR 42.5) p = 0.002, in "nonexposed" and "exposed", respectively. After the adjusted analysis, a relationship was obtained between both the variables [-9,558 (95% CI-15,794; -3,321, p = 0.03)]. CONCLUSION Higher DBI is associated with the impairment of functional status and, slightly to the deterioration of cognitive function in patients with multimorbidity. DBI should be considered in patients with multimorbidity to optimize the pharmacological treatment of a group of special interest due to its vulnerability.
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Affiliation(s)
| | - Eva Rocío Alfaro-Lara
- Andalusian Agency for Health Technology Assessment, Avda de la Innovacion, Edif ARENA 1, 41020 Seville, Spain
| | - Aitana Rodríguez-Pérez
- Pharmacy Service Hospital Virgen del Rocio, Avda Manuel Siurot s/n, 41013 Seville, Spain
| | - Daniel Báñez-Toro
- Pharmacology Department, Faculty of Pharmacy, Seville University, C/ Profesor Garcia Gonzalez, 2, 41012 Seville, Spain
| | - Susana Sánchez-Fidalgo
- Preventive Medicine and Public Health, Faculty of Medicine, Seville University, C/ Avda. Sanchez Pizjuan, s/n 41009 Seville, Spain
| | - Mª Concepción Pérez-Guerrero
- Pharmacology Department, Faculty of Pharmacy, Seville University, C/ Profesor Garcia Gonzalez, 2, 41012 Seville, Spain
| | - Bernardo Santos-Ramos
- Pharmacy Service Hospital Virgen del Rocio, Avda Manuel Siurot s/n, 41013 Seville, Spain
| | - Mª Dolores Nieto-Martín
- Internal Medicine Service, Hospital Virgen del Rocio, Avda Manuel Siurot s/n, 41013 Seville, Spain
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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Abstract
INTRODUCTION Sialorrhoea, which has been defined as excessive amount of saliva in the mouth, can be a debilitating symptom. Psychoactive drugs may cause an increase or decrease in saliva secretion. Antidepressant drugs, especially tricyclic antidepressants and less often serotonin reuptake inhibitors, are often associated with a decrease in salivation and the complaint of dry mouth. CASE PRESENTATION A 46-year-old male patient with complaints of being depressed, lack of motivation, irritability and difficulty in falling asleep was started on sertraline treatment and had trouble with sialorrhoea after the dose increase, without other causes of hypersalivation. DISCUSSION We could not find report of any case with antidepressant-associated sialorrhoea in the literature. Future cases may support a relationship between sertraline and sialorrhoea.
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Affiliation(s)
- Ebru Şahan
- Resident Medical Doctor (MD) in Psychiatry, Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - Tezer Kılıçarslan
- Medical Doctor (MD), Psychiatric Trainee, Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - İsmet Kırpınar
- Professor Doctor in Psychiatry, Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
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22
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Sheu JJ, Tsai MT, Erickson SR, Wu CH. Association between Anticholinergic Medication Use and Risk of Dementia among Patients with Parkinson's Disease. Pharmacotherapy 2019; 39:798-808. [PMID: 31251824 DOI: 10.1002/phar.2305] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVES To evaluate the association between anticholinergic medication use, categorized by anticholinergic cognitive burden (primary objective) and cumulative dose (secondary objective), and the risk of developing dementia among patients with Parkinson's disease. DESIGN Retrospective cohort study with an active comparator design. DATA SOURCE National Health Insurance Research Database in Taiwan (2001-2011). PATIENTS A total of 1232 adults with Parkinson's disease who were diagnosed between 2002 and 2004 and taking at least one antiparkinson medication during this period were included. Of these patients, 694 were exposed to anticholinergic medications categorized as mild (reference group), and 538 were exposed to anticholinergic medications categorized as moderate or severe (exposure group). MEASUREMENTS AND MAIN RESULTS Exposure to different types of anticholinergic medications was categorized by using the Anticholinergic Cognitive Burden (ACB) scale, and cumulative doses of anticholinergic medications were measured by using the cumulative minimum doses (cMD) method. Associations between anticholinergic medication use and risk of dementia were assessed by multivariable Cox proportional hazards models. The type of anticholinergics used (moderate or severe vs mild ACB) was not significantly associated with an increased risk of developing dementia (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.72-1.27). After adjusting for confounders, a high cumulative dose of anticholinergic drug (> 1095 cumulative minimum doses [cMDs]) was found to be significantly associated with an increased risk of developing dementia when compared with a low cumulative dose of anticholinergic drug (≤ 90 cMDs) (HR 3.06, 95% CI 1.35-6.97). CONCLUSION Among patients with Parkinson's disease in Taiwan, those with a high cumulative dose of anticholinergics had an increased risk of being diagnosed with dementia. Physicians should consider prescribing the lowest therapeutic dose of anticholinergic medication when making treatment decisions for patients with Parkinson's disease.
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Affiliation(s)
- Jau-Jiuan Sheu
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Steven R Erickson
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan
| | - Chung-Hsuen Wu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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23
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Vinarov AZ, Spivak LG. [Current opportunities for symptomatic treatment of dysuria]. Urologiia 2019:97-102. [PMID: 31162909] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Dysuria is the one of the most common conditions in urology. Although dysuria is not an independent disease, it accompanies a wide range of urological diseases of both infectious and non-infectious origin. Dysuria is traditionally understood as a feeling of discomfort, a burning sensation, or a sensation of pain during urination. Despite a significant reduction in the quality of life of this category of patients, pathogenetic treatment of the underlying cause is often performed in routine clinical practice, while the dysuria itself can remain without proper attention. The current possibilities of symptomatic relief of dysuria are reviewed in this article.
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Affiliation(s)
- A Z Vinarov
- Institute of Urology and Male Reproductive Health named of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - L G Spivak
- Institute of Urology and Male Reproductive Health named of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
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24
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Abstract
OBJECTIVE Extrapyramidal adverse effects of antipsychotic drugs are more reported in children. Biperiden is an anticholinergic agent to treat the adverse effects of antipsychotic drugs. The drug has the potential to induce delirium at toxic doses. However, data are scarce about delirium associated with biperiden in children. Thus far, a case of delirium has been associated with biperiden in an adolescent patient. We report the first case of delirium associated with the use of biperiden in a preadolescent patient. CASE REPORT A boy aged five years and weighing 20 kilograms had been diagnosed as having oppositional defiant disorder and separation anxiety disorder in the previous treatment center. Ten milligrams fluoxetine and 0.25 milligrams risperidone had been initiated. On the third day of treatment, dystonia developed and he was administered with biperiden. An hour later, he was brought to our emergency clinic due to disorganized speech and behavior. His vital signs were stable. There were no findings in blood and urine tests. No electrolyte imbalance, liver, kidney, and thyroid dysfunction have been observed. His neurologic examination was unremarkable and no abnormal findings were shown on cranial magnetic resonance imaging. No other system findings or findings pointing out to infectious diseases have been observed. One milligram physostigmine was administered with intravenous infusion. However, symptoms did not resolve and he was diagnosed with delirium. Naranjo Adverse Drug Reaction Probability Scale score was seven, indicating a "Probable" Adverse Drug Reaction. Half milligram haloperidol was administered bid for three days and he was discharged with complete recovery. CONCLUSION Clinicians must be aware of the risk of delirium when using non-toxic doses of biperiden in young children.
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Affiliation(s)
- Duygu Kınay
- Department of Child and Adolescent Psychiatry, Bilecik State Hospital, Bilecik, Turkey
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25
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Lozupone M, La Montagna M, D'Urso F, Piccininni C, Sardone R, Dibello V, Giannelli G, Solfrizzi V, Greco A, Daniele A, Quaranta N, Seripa D, Bellomo A, Logroscino G, Panza F. Pharmacotherapy for the treatment of depression in patients with alzheimer's disease: a treatment-resistant depressive disorder. Expert Opin Pharmacother 2018; 19:823-842. [PMID: 29726758 DOI: 10.1080/14656566.2018.1471136] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Pharmacotherapy for the treatment of depressive disorders in Alzheimer's Disease (AD) represents a clinical challenge. pharmacological options are often attempted after a period of watchful waiting (8-12 weeks). monoaminergic antidepressant drugs have shown only modest or null clinical benefits, maybe because the etiology of depressive symptoms in ad patients is fundamentally different from that of nondemented subjects. AREAS COVERED The following article looks at the selective serotonin reuptake inhibitor sertraline, which is one of the most frequently studied antidepressant medications in randomized controlled trials (RCTs). It also discusses many other pharmacological approaches that have proven to be inadequate (antipsychotics, acetylcholinesterase inhibitors, anticonvulsants, hormone replacement therapy) and new drug classes (mainly affecting glutamate transmission) that are being studied for treating depression in AD. It also gives discussion to the phase II RCT on the alternative drug S47445 and the potential effect on cognition of the multimodal antidepressant vortioxetine in older depressed patients. Finally, it discusses the N-methyl-D-aspartate antagonist ketamine. EXPERT OPINION The present RCT methodologies are too disparate to draw firm conclusions. Future studies are required to identify effective and multimodal pharmacological treatments that efficiently treat depression in AD. Genotyping may boost antidepressant treatment success.
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Affiliation(s)
- Madia Lozupone
- a Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs , University of Bari Aldo Moro , Bari , Italy
| | - Maddalena La Montagna
- b Psychiatric Unit, Department of Clinical and Experimental Medicine , University of Foggia , Foggia , Italy
| | - Francesca D'Urso
- b Psychiatric Unit, Department of Clinical and Experimental Medicine , University of Foggia , Foggia , Italy
| | - Carla Piccininni
- b Psychiatric Unit, Department of Clinical and Experimental Medicine , University of Foggia , Foggia , Italy
| | - Rodolfo Sardone
- c Department of Epidemiology and Biostatistics , National Institute of Gastroenterology "S. de Bellis" Research Hospital , Castellana Grotte, Bari , Italy
| | - Vittorio Dibello
- d Interdisciplinary Department of Medicine (DIM), Section of Dentistry , University of Bari Aldo Moro , Bari , Italy
| | - Gianluigi Giannelli
- c Department of Epidemiology and Biostatistics , National Institute of Gastroenterology "S. de Bellis" Research Hospital , Castellana Grotte, Bari , Italy
| | - Vincenzo Solfrizzi
- e Geriatric Medicine-Memory Unit and Rare Disease Centre , University of Bari Aldo Moro , Bari , Italy
| | - Antonio Greco
- f Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy
| | - Antonio Daniele
- g Institute of Neurology , Catholic University of Sacred Heart , Rome , Italy
| | - Nicola Quaranta
- h Otolaryngology Unit , University of Bari "Aldo Moro" , Bari , Italy
| | - Davide Seripa
- f Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy
| | - Antonello Bellomo
- b Psychiatric Unit, Department of Clinical and Experimental Medicine , University of Foggia , Foggia , Italy
| | - Giancarlo Logroscino
- a Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs , University of Bari Aldo Moro , Bari , Italy.,i Department of Clinical Research in Neurology , University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico" , Tricase, Lecce , Italy
| | - Francesco Panza
- a Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs , University of Bari Aldo Moro , Bari , Italy.,f Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences , IRCCS "Casa Sollievo della Sofferenza" , San Giovanni Rotondo, Foggia , Italy.,i Department of Clinical Research in Neurology , University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico" , Tricase, Lecce , Italy
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26
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Turró-Garriga O, Calvó-Perxas L, Vilalta-Franch J, Blanco-Silvente L, Castells X, Capellà D, Garre-Olmo J. Measuring anticholinergic exposure in patients with dementia: A comparative study of nine anticholinergic risk scales. Int J Geriatr Psychiatry 2018; 33:710-717. [PMID: 29292848 DOI: 10.1002/gps.4844] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/27/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe the prevalence and concordance of anticholinergic exposure according to 9 published scales, to quantify the relative weight of the drug subtypes included in each scale, and to identify clinical variables related to anticholinergic exposure. METHODS Observational and cross-sectional study using 5323 cases of dementia diagnosed in the 7 hospitals of the public health care system of the Health Region of Girona (Spain) between 2007 and 2014 and registered by the Registry of Dementias of Girona (ReDeGi). We used the Pharmacy database that includes all the drugs prescribed by specialist and primary care physicians and dispensed in pharmacies. We calculated the anticholinergic exposure using the scoring rules of each scale. Age, gender, place of residence, dementia subtype, Clinical Dementia Rating score, Mini-Mental Status Examination score, and Blessed Dementia Rating Score at the moment of dementia diagnose were retrieved from the ReDeGi. RESULTS Prevalence of the annual anticholinergic exposure ranged from 36.3% to 69.0% according to the different scales, the concordance among scales was poor to moderate, and the central nervous system drugs accounted the most for anticholinergic exposure. Being in a nursing home, having depressive symptoms, having a non-Alzheimer's dementia subtype, the number of drug treatments, and the severity of dementia were main determinants of anticholinergic exposure. CONCLUSIONS There is a large difference in outcomes among the 9 anticholinergic risk scales. Clinicians and researchers should be aware of these differences when using these instruments in patients with dementia.
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Affiliation(s)
- Oriol Turró-Garriga
- Girona Biomedical Research Institute [IDIBGI], Girona, Spain.,Institut d'Assistència Sanitària, Girona, Spain
| | | | - Joan Vilalta-Franch
- Girona Biomedical Research Institute [IDIBGI], Girona, Spain.,Institut d'Assistència Sanitària, Girona, Spain.,Department of Medical Sciences, University of Girona, Girona, Spain
| | | | - Xavier Castells
- Department of Medical Sciences, University of Girona, Girona, Spain
| | - Dolors Capellà
- Department of Medical Sciences, University of Girona, Girona, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute [IDIBGI], Girona, Spain.,Institut d'Assistència Sanitària, Girona, Spain.,Department of Medical Sciences, University of Girona, Girona, Spain
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27
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Keller N, Schmid S, Borcard A, Hämmerle B. [Not Available]. Praxis (Bern 1994) 2018; 107:263-269. [PMID: 29486647 DOI: 10.1024/1661-8157/a002901] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Zusammenfassung. In der Grundversorgerpraxis ist die überaktive Blase (OAB) bei der älteren, polymorbiden Patientin ein immer häufiger auftretendes Krankheitsbild. Die OAB wird definiert als imperativer Harndrang mit oder ohne Inkontinenz sowie Pollakisurie und Nykturie ohne Harnwegsinfektion oder andere Pathologie. Die Symptomatik schränkt die Betroffenen im Alltag deutlich ein. Das Behandlungskonzept basiert auf einer Stufentherapie. Neben Verhaltensschulung und Beckenbodentherapie gibt es auch die Möglichkeit einer medikamentösen Therapie. Diese ist jedoch wegen häufiger Nebenwirkungen und Wechselwirkungen nicht für alle Patientinnen geeignet. In Kombination mit medikamentöser Therapie oder bei Kontraindikation oder Versagen derselben gibt es die Möglichkeit der perkutanen posterioren tibialen Nervenstimulation (PTNS). Diese Therapieform kann ambulant angewendet werden, ist minimalinvasiv, nebenwirkungsarm und häufig erfolgreich.
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Abstract
Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a reliable and commonly established technique, enabling real-time guidance of transbronchial needle aspiration of mediastinal and hilar structures and parabronchial lung masses. As EBUS-TBNA became more available and adopted by clinicians, questions emerged about the optimal performance of the procedure. Although EBUS is considered safe, there are few complications that could occur during the test, correlated with both the procedure itself and the patient's characteristics. Moreover, this technique is often addressed to patients with overlapping airways diseases, which might have higher risk of complications during the procedure. Chronic obstructive pulmonary disease (COPD) patients could experience EBUS-TBNA with a relative high frequency due to their risk of developing lung cancer. The irreversible bronchial constriction characteristic of the disease raises some questions on premedication before bronchoscopic procedures. It is mandatory to optimize every aspect of the procedure in order to minimize the risk of complications, especially for fragile patients. Whether the use of inhaled bronchodilators before the procedure could improve the outcome of the procedure in COPD patients is reviewed in this article. No clear indication emerged from the literature suggesting the need of more studies in order to clarify this point.
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Affiliation(s)
- Veronica Leoni
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Patrizia Pignatti
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Dina Visca
- Respiratory Medicine Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Antonio Spanevello
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy.,Respiratory Medicine Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
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29
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Wong KKL, Tang LCY, Zhou J, Ho V. Analysis of spatiotemporal pattern and quantification of gastrointestinal slow waves caused by anticholinergic drugs. Organogenesis 2017; 13:39-62. [PMID: 28277890 DOI: 10.1080/15476278.2017.1295904] [Citation(s) in RCA: 7] [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] [Indexed: 01/20/2023] Open
Abstract
Anticholinergic drugs are well-known to cause adverse effects, such as constipation, but their effects on baseline contractile activity in the gut driven by slow waves is not well established. In a video-based gastrointestinal motility monitoring (GIMM) system, a mouse's small intestine was placed in Krebs solution and recorded using a high definition camera. Untreated controls were recorded for each specimen, then treated with a therapeutic concentration of the drug, and finally, treated with a supratherapeutic dose of the drug. Next, the video clips showing gastrointestinal motility were processed, giving us the segmentation motions of the intestine, which were then converted via Fast Fourier Transform (FFT) into their respective frequency spectrums. These contraction quantifications were analyzed from the video recordings under standardised conditions to evaluate the effect of drugs. Six experimental trials were included with benztropine and promethazine treatments. Only the supratherapeutic dose of benztropine was shown to significantly decrease the amplitude of contractions; at therapeutic doses of both drugs, neither frequency nor amplitude was significantly affected. We have demonstrated that intestinal slow waves can be analyzed based on the colonic frequency or amplitude at a supratherapeutic dose of the anticholinergic medications. More research is required on the effects of anticholinergic drugs on these slow waves to ascertain the true role of ICC in neurologic control of gastrointestinal motility.
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Affiliation(s)
- Kelvin K L Wong
- a School of Medicine, Western Sydney University , Campbelltown , NSW , Australia
| | - Lauren C Y Tang
- a School of Medicine, Western Sydney University , Campbelltown , NSW , Australia
| | - Jerry Zhou
- a School of Medicine, Western Sydney University , Campbelltown , NSW , Australia
| | - Vincent Ho
- a School of Medicine, Western Sydney University , Campbelltown , NSW , Australia
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30
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Orgen S, Deliktas H, Sahin H, Gedik A, Nergis Y. Histopathologic and Urodynamic Effects of the Anticholinergic Drugs Oxybutynin, Tolterodine, and Trospium on the Bladder. Low Urin Tract Symptoms 2017; 9:52-56. [PMID: 28120444 DOI: 10.1111/luts.12096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/24/2014] [Revised: 01/04/2015] [Accepted: 01/20/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to evaluate the effects of intravesical instillation of the anticholinergic drugs oxybutynin, tolterodine, and trospium on bladder capacity and histopathological changes in the bladder mucosa. METHODS The study included 20 male New Zealand white rabbits that were randomly allocated to four groups of five. In the oxybutynin, tolterodine, and trospium groups, the drugs used were 1 mg/kg of crushed tablet mixed with 5 mL of saline, instilled intravesically once per day for 4 weeks. The control group was administered only 5 mL of saline once per day for 4 weeks. Urodynamic measurement of the bladder was made before and after treatment. At the end of the treatment the animals were killed and the bladders were evaluated histopathologically. RESULTS There were no significant differences between pre- and post-treatment bladder capacity in any of the groups (P > 0.05). Histopathological evaluation showed that the mucosal epithelium was intact and there was minor inflammation in the control group and oxybutynin group (P > 0.05), whereas there was destruction of the mucosal epithelium and findings of diffuse inflammation in the tolterodine (P = 0.014) and trospium (P = 0.014) groups. CONCLUSION Intravesical oxybutynin treatment was observed to be safe; however, a single daily dose of oxybutynin may not be sufficient to increase bladder capacity. Intravesical use of trospium and tolterodine at high doses caused epithelial destruction and diffuse inflammation in the bladder mucosa. The irritation associated with epithelial destruction and inflammation prevented an increase in bladder capacity.
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Affiliation(s)
- Seyfettin Orgen
- Department of Urology, Batman State Hospital, Batman, Turkey
| | - Hasan Deliktas
- Department of Urology, School of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Hayrettin Sahin
- Department of Urology, School of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Abdullah Gedik
- Department of Urology, School of Medicine, Dicle University, Diyarbakir, Turkey
| | - Yusuf Nergis
- Department of Histology, School of Medicine, Dicle University, Diyarbakir, Turkey
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Dauphinot V, Faure R, Bourguignon L, Goutelle S, Krolak-Salmon P, Mouchoux C. Factors associated with changes in exposure to anticholinergic and sedative medications in elderly hospitalized patients: multicentre longitudinal study. Eur J Neurol 2016; 24:483-490. [PMID: 28026898 DOI: 10.1111/ene.13228] [Citation(s) in RCA: 8] [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: 07/11/2016] [Accepted: 11/14/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Elderly patients exposed to drugs with anticholinergic or sedative properties may have an increased risk of adverse events. This study aimed to assess the relationship between patient characteristics and changes of exposure to anticholinergic and sedative medications during their hospital stay. METHODS A multicentre longitudinal study was set up on hospitalized patients (aged ≥65 years) using at least one drug at admission. The primary outcome was change of exposure to anticholinergic and sedative drugs between admission and discharge. Sociodemographic characteristics of the patients, comorbidities, life habits and information about the hospital stay (origin of admission, reasons for hospitalization) were collected. RESULTS The study included 337 patients (mean age, 85.4 years) with an average hospital stay of 30.1 ± 37.5 days. The drug burden index increased during the hospital stay among males (P = 0.03), patients for whom the reason for hospitalization was either a stroke (P = 0.001) or inability to stay in their own home (P = 0.001), and patients with diabetes mellitus (P = 0.009). In the adjusted model, drug burden index increased among patients hospitalized for stroke, inability to stay in their own home or post-surgery, and for patients with diabetes mellitus or hypertension. CONCLUSIONS The drug management of elderly patients during hospital stays may increase exposure to anticholinergic and sedative drugs. Although the anticholinergic and sedative properties may be in relation to the therapeutic purpose, they also represent an unexpected risk. Physicians and clinical pharmacists should consider performing optimization of the drug prescriptions for patients at risk.
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Affiliation(s)
- V Dauphinot
- Centre Mémoire de Ressources et de Recherche (CMRR) de Lyon, Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne.,Centre de Recherche Clinique-Vieillissement-Cerveau-Fragilité), Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne
| | - R Faure
- Groupement Hospitalier Edouard Herriot, Service Pharmaceutique, Hospices Civils de Lyon, Lyon
| | - L Bourguignon
- Groupement Hospitalier de Gériatrie, Service Pharmaceutique, Hospices Civils de Lyon, Lyon.,ISPB - Faculté de Pharmacie de Lyon, Université Lyon 1, Lyon
| | - S Goutelle
- Groupement Hospitalier de Gériatrie, Service Pharmaceutique, Hospices Civils de Lyon, Lyon.,ISPB - Faculté de Pharmacie de Lyon, Université Lyon 1, Lyon
| | - P Krolak-Salmon
- Centre Mémoire de Ressources et de Recherche (CMRR) de Lyon, Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne.,Centre de Recherche Clinique-Vieillissement-Cerveau-Fragilité), Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne.,U1028, INSERM, Université Lyon 1, Lyon.,UMR CNRS 5292, Centre de Recherche en Neurosciences de Lyon, Lyon
| | - C Mouchoux
- Centre de Recherche Clinique-Vieillissement-Cerveau-Fragilité), Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne.,Groupement Hospitalier de Gériatrie, Service Pharmaceutique, Hospices Civils de Lyon, Lyon.,UMR CNRS 5558, Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, Villeurbanne, France
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Ng DB, McCart M, Klein C, Campbell C, Schoenhaus R, Berner T. Evaluating Outcomes in Patients with Overactive Bladder within an Integrated Healthcare Delivery System Using a Treatment Patterns Analyzer. Am Health Drug Benefits 2016; 9:343-353. [PMID: 27924187 PMCID: PMC5123653] [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] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/03/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Overactive bladder (OAB) is a relatively common disease that has been linked to a variety of comorbidities, reductions in quality of life, and increased healthcare costs. Antimuscarinic agents are the standard of care among pharmacologic treatments for OAB, but these drugs are linked to high levels of anticholinergic burden, especially in the elderly. OBJECTIVE To demonstrate how efficient data analysis can be used to identify gaps in care as a result of improvement strategies for OAB within an integrated healthcare delivery system setting. METHODS We developed an OAB treatment patterns analyzer, a clinical outcomes software analysis program, to identify gaps in care, high anticholinergic burden, and potential quality improvement initiatives. Deidentified pharmacy and medical claims data from an integrated delivery network were imported into the OAB treatment patterns analyzer. Patients with a diagnosis of OAB who were continuously enrolled in the network between January 1, 2009, and December 31, 2013, were identified and were imported into the analyzer. The analyzer used National Drug Code; International Classification of Diseases, Ninth Edition, Clinical Modification; Current Procedural Terminology; and UB-92 codes to measure treatment patterns, comorbid conditions, anticholinergic burden, concomitant use with anticholinesterases, costs, and healthcare resource utilization. RESULTS Of 157,710 members in the integrated delivery network population, 7309 patients met the study eligibility criteria. Of patients taking medications for OAB, 85% were nonadherent and 73% discontinued treatment within 1 year. Among 1147 patients in the integrated healthcare delivery system who were using medications for OAB, 39 (3.4%) patients were concomitantly taking anticholinesterase drugs and an antimuscarinic agent. The per-month plan-paid cost per member was $318.67. Of all the patients with OAB within the population, the rates of all-cause office visits, emergency department visits, and hospitalizations were 81%, 6%, and 4%, respectively. The rate of clinically relevant anticholinergic burden was 16%, with higher rates among patients with dementia who were also receiving a branded (20%) or generic (24%) antimuscarinic drug. CONCLUSION In patients using medications for the treatment of OAB, the rates of medication persistence and adherence were poor. Antimuscarinic medications may place certain patient populations at risk for increased anticholinergic burden. Data included in the analyzer can be used to implement member-specific strategies to prevent poor outcomes and reduce associated healthcare costs and utilization.
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Affiliation(s)
- Daniel B Ng
- Associate Director, Health Economics and Clinical Outcomes Research, Astellas Pharma Global Development, Northbrook, IL
| | - Melissa McCart
- Assistant Director, Global Health Economics and Outcomes Research, Xcenda, Palm Harbor, FL
| | | | - Chelsey Campbell
- Assistant Director, Global Health Economics and Outcomes Research, Xcenda
| | | | - Todd Berner
- Director, Health Economics and Clinical Outcomes Research, Astellas Scientific and Medical Affairs, Northbrook, IL
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Hu B, Li C, Pan M, Zhong M, Cao Y, Zhang N, Yuan H, Duan H. Strategies for the prevention of catheter-related bladder discomfort: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2016; 95:e4859. [PMID: 27631249 PMCID: PMC5402592 DOI: 10.1097/md.0000000000004859] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The ideal measures to prevent postoperative catheter-related bladder discomfort (CRBD) remain unestablished. We conducted the systematic review and meta-analysis to clarify the significance of potential interventions. METHODS We followed the Preferred Reporting Items for Systematic review and Meta-Analysis statement guidelines, and searched databases from MEDLINE, EMBASE, and referred Cochrane Library for randomized clinical trials (RCTs) published before December 2014. Reference lists from reviews or related articles were screened and checked for the related RCTs. Data extraction was performed carefully by 2 authors, respectively, and methodological quality was assessed by scoring system. Meta-analysis was applied for studies using the similar strategies or same reagents on the similar participants focused on CRBD. The primary outcome measure was the incidence of postoperative CRBD. RESULTS We identified 8 RCTs with interventions ranging from perioperative managements to pharmacological or multicomponent interventions. Meta-analysis showed ketamine was associated with less incidence of CRBD compared with placebo (pool risk ratio [RR] = -0.75, 95% confidence interval [CI] = 0.17-3.44, P < 0.01) at 0 hour, 1 hour (RR = -0.26, 95%CI = -0.38 to -0.13, P < 0.01), and 2 hours (RR = 0.31, 95%CI = 0.17-0.55, P < 0.01) and 6 hours (RR = 0.23, 95% CI = 0.11-0.49, P < 0.01) after operation. Oxybutynin did not affect the incidence of CRBD (RR = 0.46, 95%CI = 0.20-1.03, P = 0.06). Anticholinergic drugs also lower the incidence of CRBD at 0 hour (RR = 0.52, 95% CI = 0.38-0.71, P < 0.01), 1 hour (RR = 0.66, 95% CI = 0.51-0.86, P < 0.01), 2 hours (RR = 0.62, 95% CI = 0.46-0.84, P < 0.01), and 6 hours (RR = 0.56, 95%CI = 0.38-0.81, P < 0.01) postoperatively. Tramadol and gabapentin were also useful in lower the incidence and severity of CRBD in a RCT with 50 patients. CONCLUSION The included studies showed great effectiveness in incidence of postoperative CRBD. Meta-analysis supported that ketamine, oxybutynin, and anticholinergic reagents interventions were useful in preventing postoperative catheter-related bladder discomfort.
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Affiliation(s)
- Baoji Hu
- Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, Shanghai
| | - Chengbao Li
- Department of Medicine, Hebei North University, Zhangjiakou, Hebei
| | - Mengzhi Pan
- Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, Shanghai
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai
| | - Yu Cao
- Ningxiang Hospital Affiliated to Hunan University of Chinese Medicine, Changsha, Hunan
| | - Nannan Zhang
- Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, Shanghai
| | - Hongbin Yuan
- Department of Anesthesiology, Changzheng Hospital, the Second Military Medical University, Shanghai China
- Correspondence: Hongbin Yuan, Department of Anesthesiology, Changzheng Hospital, the Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China (e-mail: ); Hongwei Duan, Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai 201399, China (e-mail: )
| | - Hongwei Duan
- Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, Shanghai
- Correspondence: Hongbin Yuan, Department of Anesthesiology, Changzheng Hospital, the Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China (e-mail: ); Hongwei Duan, Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai 201399, China (e-mail: )
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Cioplean ED, Camburu LR. TRANSITORY CONSECUTIVE ESOTROPIA AFTER AMITRIPTYLINE TREATMENT FOR NOCTURNAL ENURESIS -CASE REPORT. Rom J Ophthalmol 2015; 59:116-118. [PMID: 26978874 PMCID: PMC5712929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 06/05/2023] Open
Abstract
We report the case of a 9-year-old child operated for intermittent exotropia and V-pattern with a good result 2 months after bilateral Lateral Rectus Muscle Recession. The binocular vision was restored in primary position and down-gaze with excellent stereopsis at near and distance and a deviation of +4 PD in primary position. Three months later, the patient developed a consecutive esotropia of + 18 PD in primary position with diplopia in all gazes triggered by Amitriptyline treatment prescribed one month earlier for nocturnal enuresis. Diplopia was solved in time after anticholinergic medication cessation. During the recovery period, Fresnell prisms have been used in order to eliminate diplopia. Three months after diplopia onset, the binocular vision was restored showing a transitory and reversible effect of the Amitriptyline treatment. Fusion vulnerability can be a possible risk factor in developing diplopia and esotropia in patients treated with anticholinergic drugs.
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Abstract
INTRODUCTION Anticholinergic drugs are associated with poor outcomes in older patients but no specific intervention strategies aimed at reducing anticholinergic drug exposure have been described. OBJECTIVES To identify whether a consultant-led medication review targeting anticholinergics would reduce anticholinergic drug exposure [number of anticholinergic drugs and Anticholinergic Risk Scale (ARS) score]. METHODS The first phase of the audit included 70 consecutive admissions (mean age 84 years, 53 women). ARS score was calculated on admission and after initial consultant review. Re-audit was undertaken on another 70 consecutive admissions (mean age 83 years, 43 women) after introducing a system of informing the responsible consultant of the ARS score at their first review. RESULTS Drugs with anticholinergic effects (n = 53) were prescribed preadmission to 45/140 (32%) of patients. Consultant geriatrician review reduced ARS scores (p = 0.01), especially following the introduction of the information system (p = 0.002). In the first arm of the audit, 51 (73%) patients had ARS of 0 after a consultant's review compared with 47 (67%) patients on admission, whilst 67 (96%) patients had ARS of 2 or less after a consultant's review compared with 63 (90%) patients on admission. In the second arm of the audit, 59 (84%) patients had ARS of 0 after a consultant's review compared with 48 (69%) patients on admission, whilst 70 (100%) patients had ARS of 2 or less after a consultant's review compared with 69 (99%) patients on admission. Anticholinergic drugs were either stopped, or their dose reduced, in 35% of patients in the first arm of the audit and in 73% of patients in the re-audit (odds ratio 5.0, 95% confidence interval 1.4-17.8). CONCLUSION Consultant-led medication review (standard practice) was effective at reducing anticholinergic drug exposure in the acute setting. A system of alerting clinicians to patients prescribed anticholinergic medications further reduced anticholinergic drug exposure.
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Affiliation(s)
- Hui Sian Tay
- Department of Medicine for the Elderly, Ward 102, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - Roy L Soiza
- Department of Medicine for the Elderly, Aberdeen Royal Infirmary, NHS Grampian, and Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Abstract
BACKGROUND Botulinum neurotoxin (BoNT) injection into the bladder wall has been shown to be an effective alternative to anticholinergic (antimuscarinic) medications and more invasive surgery in those with multiple sclerosis and spinal cord injury with neurogenic detrusor overactivity (NDO) and urinary incontinence who are not tolerating anticholinergic medications. In August 2011, Botox(®) (onabotulinumtoxinA) received Food and Drug Administration (FDA) approval for this use. Clinically, intradetrusor injection of BoNT has been found to decrease urinary incontinence and improve quality of life. Its impact on urodynamic parameters is an increase in the maximum cystometric (bladder) capacity and decrease in the maximum detrusor pressures. The most common side effects are urinary tract infections and urinary retention. There have been rare reports and a black box warning of distant spread of BoNT. BoNT has gained popularity because of its effectiveness and long duration of action, relative ease of administration, easy learning curve, reproducibility of results on repeated administration, and low incidence of complications. OBJECTIVE To discuss the structure and function, mechanisms of action, clinical and urodynamic studies, injection technique, potential beneficial and adverse effects, and potential areas of research of BoNT. METHODS Literature search focused on botulinum toxin in MEDLINE/PubMed. Search terms included botulinum toxin, neurogenic bladder, NDO, botox bladder, botox spinal cord injury, botox, FDA, botox side effects. All papers identified were English language, full-text papers. In addition, English abstracts of non-English papers were noted. The reference list of identified articles was also searched for further papers. CONCLUSION Botulinum toxin is an alternative treatment for individuals with NDO who fail to tolerate anticholinergic medications. Its popularity has increased because of the literature, which has supported its effectiveness, safety, easy use and learning curve, reproducibility of results on repeated use, and recent FDA approval of Botox(®) (onabotulinumtoxinA).
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Affiliation(s)
- Todd A. Linsenmeyer
- Correspondence to: Todd A. Linsenmeyer, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
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Mauseth SA, Skurtveit S, Spigset O. Adherence, persistence and switch rates for anticholinergic drugs used for overactive bladder in women: data from the Norwegian Prescription Database. Acta Obstet Gynecol Scand 2013; 92:1208-15. [PMID: 23763552 DOI: 10.1111/aogs.12196] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 11/27/2012] [Accepted: 06/03/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the pattern of use of anticholinergic drugs for overactive bladder among women in Norway with regard to persistence, adherence and switch rates. DESIGN Observational study. SETTING AND SAMPLE Data from the Norwegian Prescription Database on prescriptions for tolterodine, solifenacin, darifenacin and fesoterodine filled in Norwegian pharmacies from 1 January 2004 to 31 December 2010. METHODS AND MAIN OUTCOME MEASURES Data from the database were analysed at an individual level, and drug persistence, discontinuation rates and switch rates during a follow-up period of 365 days after the first prescription were calculated. RESULTS Overall 1-year persistence for new users was 38.0%. Within the same period, a total of 10.3% switched from the index drug to another drug in the same group, whereas 51.7% discontinued without switching. Users of solifenacin and tolterodine were somewhat more persistent than users of darifenacin and fesoterodine. Persistence was lowest (20.9%) in the age group 18-39 years, increased with age and was highest in the age groups 70-79 years and 80 years and above (43.5 and 43.3%, respectively). In total, 31.9% filled only one prescription of the drug and, of these, only one of four women switched to another drug. The proportion who were adherent during treatment was 60.4%. CONCLUSIONS The discontinuation rate for anticholinergic drugs for overactive bladder in women is high. The reasons why patients stop using them remain obscure but could be related both to a limited clinical effect and an unacceptable adverse effect burden.
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Affiliation(s)
- Siri A Mauseth
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
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Pitkala KH, Juola AL, Soini H, Laakkonen ML, Kautiainen H, Teramura-Gronblad M, Finne-Soveri H, Bjorkman M. Reducing inappropriate, anticholinergic and psychotropic drugs among older residents in assisted living facilities: study protocol for a randomized controlled trial. Trials 2012; 13:85. [PMID: 22709731 PMCID: PMC3541247 DOI: 10.1186/1745-6215-13-85] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 06/18/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Use of inappropriate drugs is common among institutionalized older people. Rigorous trials investigating the effect of the education of staff in institutionalized settings on the harm related to older people's drug treatment are still scarce. The aim of this trial is to investigate whether training professionals in assisted living facilities reduces the use of inappropriate drugs among residents and has an effect on residents' quality of life and use of health services. METHODS AND DESIGN During years 2011 and 2012, a sample of residents in assisted living facilities in Helsinki (approximately 212) will be recruited, having offered to participate in a trial aiming to reduce their harmful drugs. Their wards will be randomized into two arms: one, those in which staff will be trained in two half-day sessions, including case studies to identify inappropriate, anticholinergic and psychotropic drugs among their residents, and two, a control group with usual care procedures and delayed training. The intervention wards will have an appointed nurse who will be responsible for taking care of the medication of the residents on her ward, and taking any problems to the consulting doctor, who will be responsible for the overall care of the patient. The trial will last for twelve months, the assessment time points will be zero, six and twelve months. The primary outcomes will be the proportion of persons using inappropriate, anticholinergic, or more than two psychotropic drugs, and the change in the mean number of inappropriate, anticholinergic and psychotropic drugs among residents. Secondary endpoints will be, for example, the change in the mean number of drugs, the proportion of residents having significant drug-drug interactions, residents' health-related quality of life (HRQOL) according to the 15D instrument, cognition according to verbal fluency and clock-drawing tests and the use and cost of health services, especially hospitalizations. DISCUSSION To our knowledge, this is the first large-scale randomized trial exploring whether relatively light intervention, that is, staff training, will have an effect on reducing harmful drugs and improving QOL among institutionalized older people. TRIAL REGISTRATION ACTRN12611001078943.
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Affiliation(s)
- Kaisu H Pitkala
- Unit of General Practice, Helsinki University Central Hospital and Department of General Practice, University of Helsinki, Tukholmankatu 8 B, 00014, University of Helsinki, Finland
| | - Anna-Liisa Juola
- Unit of General Practice, Helsinki University Central Hospital and Department of General Practice, University of Helsinki, Tukholmankatu 8 B, 00014, University of Helsinki, Finland
- Kuusankoski Health Center, Kauppalankatu 14 3 krs, 45101, Kouvola, Finland
| | - Helena Soini
- Social Services Department, Services for Elderly, Health Center, Toinen linja 4 A, 00099, Helsinki, Finland
| | - Marja-Liisa Laakkonen
- Unit of General Practice, Helsinki University Central Hospital and Department of General Practice, University of Helsinki, Tukholmankatu 8 B, 00014, University of Helsinki, Finland
- Helsinki Health Center, Laakso Hospital, Lääkärikatu 8, 00250, Helsinki, Finland
| | - Hannu Kautiainen
- Family Practice Unit, Central Finland Central Hospital, Jyväskylä, Finland and Primary Health Care Unit, Kuopio University Hospital, Hämeentie 1, 44100, Äänekoski, Finland
| | | | - Harriet Finne-Soveri
- National Institute for Health and Welfare, Lintulahdenkuja 4, 00271, Helsinki, Finland
| | - Mikko Bjorkman
- Clinics of Internal Medicine and Geriatrics, Helsinki University Central Hospital, Haartmaninkatu 8 B, 00029, Helsinki, Finland
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