Potentially Inappropriate Medication, Anticholinergic Burden, and Mortality in People Attending Memory Clinics

Article type: Research Article

Authors: Cross, Amanda J.^a | George, Johnson^a | Woodward, Michael C.^b | Ames, David^{c; d} | Brodaty, Henry^{e; f} | Wolfe, Rory^g | Connors, Michael H.^{e; f} | Elliott, Rohan A.^{a; h; *}

Affiliations: [a] Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia | [b] Medical and Cognitive Research Unit, Austin Health, Heidelberg, VIC, Australia | [c] National Ageing Research Institute, Parkville, VIC, Australia | [d] University of Melbourne Academic Unit for Psychiatry of Old Age, St George’s Hospital, Kew, VIC, Australia | [e] Dementia Collaborative Research Centre, School of Psychiatry, UNSW Australia, Sydney, NSW, Australia | [f] Center for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, NSW, Australia | [g] Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia | [h] Pharmacy Department, Austin Health, Heidelberg, VIC, Australia

Correspondence: [*] Correspondence to: Rohan A. Elliott, Pharmacy Department, Austin Health, PO Box 5555, Heidelberg, VIC 3084, Australia. Tel.: +61 3 9496 2334; Fax: +61 3 9496 5900; E-mail: [email protected].

Abstract: Background:There is limited evidence regarding the association between potentially inappropriate medications (PIM) and mortality in older people with cognitive impairment. Objective:To examine whether use of medications considered to be potentially inappropriate in older people with cognitive impairment (PIMcog) and anticholinergic cognitive burden (ACB) were associated with mortality in people who attended memory clinics. Methods:Cross-sectional and longitudinal analyses of data from the Prospective Research In MEmory clinics (PRIME) study. Participants were community-dwelling people who attended nine memory clinics and had a diagnosis of mild cognitive impairment or dementia. PIMcog was defined as any medication considered potentially inappropriate for a person with cognitive impairment according to Beers or STOPP criteria. Anticholinergic burden was calculated using the ACB scale. Time-dependent Cox-proportional hazards regression was used to analyze associations between PIMcog use/ACB score and all-cause mortality over a three-year follow-up period. The regression model included the baseline variables: age, gender, education, cognitive diagnoses, total number of medications, disease-burden, cognition, physical function, and neuropsychiatric symptoms. Results:Of 964 participants, 360 (37.3%) used one or more PIMcog at some time during the study; most commonly anticholinergics and sedatives. 624 (64.7%) participants used a medication with potential or definite anticholinergic properties (ACB>0) at some point during the study. Both PIMcog use (adjusted hazard ratio: 1.42 95% CI: 1.12–1.80) and ACB score (adjusted hazard ratio: 1.18 95% CI: 1.06–1.32) were associated with mortality. Conclusion:Use of PIMcogs and medications with anticholinergic properties was common among memory clinic patients and both were associated with mortality.

Keywords: Alzheimer’s disease, cholinergic antagonists, cognitive dysfunction, dementia, inappropriate prescribing, mortality, potentially inappropriate medication list, contstartabstract

DOI: 10.3233/JAD-170265

Journal: Journal of Alzheimer's Disease, vol. 60, no. 2, pp. 349-358, 2017