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.
['Krüger|Caroline|C|http://orcid.org/0000-0001-9080-1562', 'Schäfer|Ingmar|I|http://orcid.org/0000-0002-1038-7478', 'van den Bussche|Hendrik|H|', 'Bickel|Horst|H|', 'Fuchs|Angela|A|', 'Gensichen|Jochen|J|', 'König|Hans-Helmut|HH|', 'Maier|Wolfgang|W|', 'Mergenthal|Karola|K|', 'Riedel-Heller|Steffi G|SG|', 'Schön|Gerhard|G|', 'Weyerer|Siegfried|S|', 'Wiese|Birgitt|B|', 'von Renteln-Kruse|Wolfgang|W|', 'Langebrake|Claudia|C|', 'Scherer|Martin|M|']
D000368:Aged D018680:Cholinergic Antagonists D003071:Cognition D005260:Female D005858:Germany D006801:Humans D008137:Longitudinal Studies D008297:Male D004364:Pharmaceutical Preparations
primary care clinical pharmacology epidemiology