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Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: a randomized controlled trial

Authors

Kersten, H., Molden, E., Tolo, I. K., Skovlund, E., Engedal, K., Wyller, T. B.

Journal

The Journals Of Gerontology. Series A, Biological Sciences And Medical Sciences, Volume: 68, No.: 3, Pages.: 271-278

Year of Publication

2013

Abstract

Background: Observational studies report a relationship between anticholinergic drug scale (ADS) score and cognitive function. This study investigated whether a reduced ADS score improved cognitive function in a frail elderly population.; Methods: This randomized, controlled, single-blinded trial, recruited long-term residents with an ADS score of greater than or equal to 3 from 22 nursing homes in Norway. The participants were randomly allocated (1:1) to intervention or control. The intervention was a pharmacist-initiated reduction of ADS score after multidisciplinary drug reviews. Primary end point was Consortium to Establish a Registry for Alzheimer’s Disease 10-wordlist test for immediate recall. Secondary end points were Mini-Mental Sate Examination, delayed recall and recognition of words, saliva flow, and serum anticholinergic activity (SAA).The participants were retested after 4 and 8 weeks, and the study groups were compared after adjusting for baseline differences.; Results: Eighty-seven patients were included. The median ADS score was reduced by 2 units (p < .0001) in the intervention group and remained unchanged in the control group. After 8 weeks, the adjusted mean difference in immediate recall was 0.54 words between the intervention and control group (95% confidence interval [CI]: -0.91, 2.05; p = .48). The study groups did not differ significantly in any of the other cognitive end points, salvia flow, or SAA at either follow-up (p > .18).; Conclusion: Pharmacist-initiated drug changes significantly reduced ADS score but did not improve cognitive function in nursing home residents. Moreover, the drug changes did not reduce SAA or mouth dryness significantly, which might indicate limited applicability of the ADS score to prevent prescription risks in this population.;

Bibtex Citation

@article{Kersten_2012, doi = {10.1093/gerona/gls176}, url = {http://dx.doi.org/10.1093/gerona/gls176}, year = 2012, month = {sep}, publisher = {Oxford University Press ({OUP})}, volume = {68}, number = {3}, pages = {271--278}, author = {H. Kersten and E. Molden and I. K. Tolo and E. Skovlund and K. Engedal and T. B. Wyller}, title = {Cognitive Effects of Reducing Anticholinergic Drug Burden in a Frail Elderly Population: A Randomized Controlled Trial}, journal = {The Journals of Gerontology Series A: Biological Sciences and Medical Sciences} }

Keywords

administration & dosage, adverse effects, aged, 80 and over, anticholinergic, blood, cholinergic antagonists, cognition, drug utilization review, drugs, female, frail elderly, humans, in, male, mental recall, neuropsychological tests, nursing homes, of, pharmacists, reduction, salivation, use

Countries of Study

Norway

Types of Dementia

Mild Cognitive Impairment (MCI)

Types of Study

Randomised Controlled Trial

Type of Outcomes

Cognition, Service use or cost reductions (incl. hospital use reduction, care home admission delay)

Settings

Nursing Homes

Type of Interventions

Pharmaceutical Interventions, Workforce oriented interventions

Pharmaceutical Interventions

Other

Workforce Interventions

Professional Training / Continuing Professional Development