215 - ECN Awards: Anticholinergic Burden: A Study in a Psychiatry of Later Life Cohort

Abstract

Background

Medications with anticholinergic activity are widely prescribed for a variety of medical, surgical, and psychiatric illnesses. There is strong evidence that the cumulative anticholinergic properties of such medications (i.e., the anticholinergic burden) contributes to significant longer-term adverse effects, including dementia, impaired mobility, and increased mortality. Despite this, the anticholinergic burden is often not given due consideration when cliniciansprescribe or review medications in routine clinical practice. This is of particularrelevance in services working with elderly patient populations, who are both more likely to experience polypharmacy and more vulnerable to medication adverse effects. Greater awareness of the risks of anticholinergic prescribing may lead to improvements in longer-term cognitive and physical functioning,and subsequently decreased disease burden on individuals and society as a whole.

Objectives/Aims

To identify and quantify anticholinergic burden among all patients currentlyattending a rural Psychiatry of Later Life service.

Methods

This was a cross-sectional observational study. Chart reviews were carried out on all patients open to the service at the time of the study in November 2020. Each patient’s medication regime was analysed to calculate its overall score onthe Anticholinergic Effect on Cognition Scale (AEC), using an online tool developed by South London and Maudsley NHS Foundation Trust. Other variables such as each patient’s age, sex, and cognitive status (categorized as no cognitive impairment; mild cognitive impairment (MCI); or dementia) were also documented. Data was anonymised on collection. AEC scores of 2 or morewere deemed to be at threshold for ‘review and withdraw or switch’ of medications.

Results

A total of 80 patients were included in the study (48 female; mean age 77 [SD = 6.5] years). 45% of patients had a documented diagnosis of dementia, 11%had a documented diagnosis of MCI and 44% had no documented cognitive impairment. Overall, the majority of patients (53.75%) were found to have an AEC score of 2 or greater (AEC range 0-6, mean 2.5 [SD = 1.5]). Of patients with a diagnosis of dementia, 58% were found to have an AEC of 2 or greater.

Conclusions

The possible detrimental effects of prescribed medication on cognition and physical health are likely under-recognised in routine clinical practice. Greaterawareness of the anticholinergic properties of a wide variety of commonly prescribed medication may lead to more selective and informed prescribing.

Abstract has been accepted for a poster presentation at the British Association for Psychopharmacology Summer Meeting (July 2021), and at the European College of Neuropsychopharmacology Annual Congress (October 2021).