Anticholinergic Medication Burden in Parkinson’s Disease Outpatients

Article type: Research Article

Authors: Nawaz, Huma^a | Sargent, Lana^{b; c; d; e} | Quilon, Helengrace^f | Cloud, Leslie J.^a | Testa, Claudia M.^a | Snider, Jon D.^a | Lageman, Sarah K.^{a; g} | Baron, Mark S.^{a; h} | Berman, Brian D.^a | Zimmerman, Kristin^c | Price, Elvin T.^{c; d; e} | Mukhopadhyay, Nitai D.ⁱ | Barrett, Matthew J.^{a; *}

Affiliations: [a] Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA | [b] School of Nursing, Virginia Commonwealth University, Richmond, VA, USA | [c] Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA | [d] Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA | [e] Institute for Inclusion, Inquiry & Innovation (iCubed): Health & Wellness in Aging Populations Core, Richmond, VA, USA | [f] Virginia Commonwealth University, Richmond, VA, USA | [g] Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA | [h] Southeast Veterans Affairs Parkinson’s Disease Research, Education and Clinical Center (PADRECC), Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA | [i] Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA

Correspondence: [*] Correspondence to: Matthew J. Barrett, MD, MSc, Virginia Commonwealth University, Department of Neurology, 1101 East Marshall Street, Box 980599, Richmond, VA 23298-0599, USA. Tel.: +1 804 628 2659; E-mail: Matthew.Barrett@vcuhealth.org.

Abstract: Background:Individuals with Parkinson’s disease (PD) may be especially vulnerable to future cognitive decline from anticholinergic medications. Objective:To characterize anticholinergic medication burden, determine the co-occurrence of anticholinergic and cholinesterase inhibitors, and to assess the correlations among anticholinergic burden scales in PD outpatients. Methods:We studied 670 PD outpatients enrolled in a clinic registry between 2012 and 2020. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Drug Burden Index-Anticholinergic component (DBI-Ach). Correlations between scales were assessed with weighted kappa coefficients. Results:Between 31.5 to 46.3% of PD patients were taking medications with anticholinergic properties. Among the scales applied, the ACB produced the highest prevalence of medications with anticholinergic properties (46.3%). Considering only medications with definite anticholinergic activity (scores of 2 or 3 on ACB, ADS, or ARS), the most common anticholinergic drug classes were antiparkinsonian (8.2%), antipsychotic (6.4%), and urological (3.3%) medications. Cholinesterase inhibitors and medications with anticholinergic properties were co-prescribed to 5.4% of the total cohort. The most highly correlated scales were ACB and ADS (κ= 0.71), ACB and ARS (κ= 0.67), and ADS and ARS (κ= 0.55). Conclusion:A high proportion of PD patients (20%) were either taking antiparkinsonian, urological, or antipsychotic anticholinergic medications or were co-prescribed anticholinergic medications and cholinesterase inhibitors. By virtue of its detection of a high prevalence of anticholinergic medication usage and its high correlation with other scales, our data support use of the ACB scale to assess anticholinergic burden in PD patients.

Keywords: Parkinson’s disease, Parkinson’s disease dementia, anticholinergic medications, cholinesterase inhibitors

DOI: 10.3233/JPD-212769

Journal: Journal of Parkinson's Disease, vol. 12, no. 2, pp. 599-606, 2022