Anticholinergic drug burden according to the anticholinergic drug scale and the German anticholinergic burden and their impact on cognitive function in multimorbid elderly German people: a multicentre observational study

  • Objectives The aims of our study were to examine the anticholinergic drug use and to assess the association between anticholinergic burden and cognitive function in the multimorbid elderly patients of the MultiCare cohort. Setting MultiCare was conducted as a longitudinal cohort study in primary care, located in eight different study centres in Germany. Participants 3189 patients (59.3% female). Primary and secondary outcome measures Baseline data were used for the following analyses. Drugs were classified according to the well-established anticholinergic drug scale (ADS) and the recently published German anticholinergic burden (German ACB). Cognitive function was measured using a letter digit substitution test (LDST) and a mixed-effect multivariate linear regression was performed to calculate the influence of anticholinergic burden on the cognitive function. Results Patients used 1764 anticholinergic drugs according to ADS and 2750 anticholinergics according to the German ACB score (prevalence 38.4% and 53.7%, respectively). The mean ADS score was 0.8 (±1.3), and the mean German ACB score was 1.2 (±1.6) per patient. The most common ADS anticholinergic was furosemide (5.8%) and the most common ACB anticholinergic was metformin (13.7%). The majority of the identified anticholinergics were drugs with low anticholinergic potential: 80.2% (ADS) and 73.4% (ACB), respectively. An increasing ADS and German ACB score was associated with reduced cognitive function according to the LDST (−0.26; p=0.008 and −0.24; p=0.003, respectively). Conclusion Multimorbid elderly patients are in a high risk for using anticholinergic drugs according to ADS and German ACB score. We especially need to gain greater awareness for the contribution of drugs with low anticholinergic potential from the cardiovascular system. As anticholinergic drug use is associated with reduced cognitive function in multimorbid elderly patients, the importance of rational prescribing and also deprescribing needs to be further evaluated. Trial registration number ISRCTN89818205.
Author:Caroline KrügerORCiDGND, Ingmar SchäferORCiDGND, Hendrik van den BusscheORCiDGND, Horst BickelGND, Angela FuchsGND, Jochen GensichenORCiDGND, Hans-Helmut KönigGND, Wolfgang MaierGND, Karola MergenthalGND, Steffi Gerlinde Riedel-HellerORCiDGND, Gerhard SchönORCiDGND, Siegfried WeyererORCiDGND, Birgitt WieseORCiDGND, Wolfgang von Renteln-KruseGND, Claudia LangebrakeGND, Martin SchererGND
Parent Title (English):BMJ open
Publisher:BMJ Publishing Group
Place of publication:London
Document Type:Article
Date of Publication (online):2021/03/23
Date of first Publication:2021/03/23
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2023/10/09
Issue:3, art. e044230
Article Number:e044230
Page Number:10
First Page:1
Last Page:10
The study was funded by the German Federal Ministry of Education and Research (grant numbers 01ET0725-31 and 01ET1006A-K).
Data availability statement Data are available on reasonable request. The data that support the findings of this study are available from Professor Hendrik van den Bussche, but restrictions apply to the availability of these data, which were used under licence for the current study, and so are not publicly available. Data are however available from the authors on reasonable request and with permission of Professor Hendrik van den Bussche.
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - CC BY-NC - Namensnennung - Nicht kommerziell 4.0 International