Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes

Wen-Han Hsu; Yu-Wen Wen; Liang-Kung Chen; Fei-Yuan Hsiao

doi:10.1370/afm.2131

Published eLetters

If you would like to comment on this article, click on Submit a Response to This article, below. We welcome your input.

Submit a Response to This Article

Compose eLetter

Title *

Author Information

Contributors
First Name and Middle Initial * First or given name, e.g. 'Peter'. Last Name * Your last, or family, name, e.g. 'MacMoody'. Email Address * Your email address, e.g. higgs-boson@gmail.com Occupation * Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Affiliation * Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

What code is in the image? *

Enter the characters shown in the image.

Vertical Tabs

Jump to comment:

Does the Use of Anticholinergic Scales Truly Measure Anticholinergic Adverse Outcomes?
Pasi Lampela

Published on: 04 January 2018

Published on: (4 January 2018)
Page navigation anchor for Does the Use of Anticholinergic Scales Truly Measure Anticholinergic Adverse Outcomes?
Does the Use of Anticholinergic Scales Truly Measure Anticholinergic Adverse Outcomes?
Pasi Lampela, Adjunct Professor
Other Contributors:
We read the article by Hsu et al. (2017) with great interest. The results achieved with this longitudinal approach were interesting and the large study population increases the validity of the results.
The authors concluded that the Anticholinergic Cognitive Burden Scale (ACB) showed the strongest and most consistent dose-response relationships among adverse outcomes. In the study, the commonly used drugs classif...
Show More

We read the article by Hsu et al. (2017) with great interest. The results achieved with this longitudinal approach were interesting and the large study population increases the validity of the results.
The authors concluded that the Anticholinergic Cognitive Burden Scale (ACB) showed the strongest and most consistent dose-response relationships among adverse outcomes. In the study, the commonly used drugs classified in the ACB scale were cardiovascular drugs with the lowest anticholinergic score of 1, 'possible anticholinergics' (1). Apart from strong anticholinergics such as atropine, there is no consensus about the anticholinergic properties of several drugs, and many classifications differing from each other have been developed (2). In addition to anticholinergic (ie., antagonism of muscarinic receptors) adverse effects, similar adverse effects may arise also from other reasons caused by other pharmacological mechanisms of drugs or disease-related factors. E.g. use of benzodiazepines may decrease cognition and cause falls, but this is not likely to be a result from antimuscarinic effects.
It would be interesting to know, if the adverse clinical outcomes reported in the study may result from other reasons than antimuscarinic effect (e.g. hypotension caused by increased number or higher dose of cardiovascular medication). In addition, would the results change if only 'definitive anticholinergics' (score 2-3) from the ACB were used in analysis? This sub-analysis may clarify, if prescribing several 'possible anticholinergics' such as cardiovascular drugs makes any clinical difference compared to use of only one or few strong anticholinergics.
References:
1. http://www.agingbraincare.org/uploads/products/ACB_scale_- _legal_size.pdf
2. Salahudeen MS, Duffull SB, Nishtala PS. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr. 2015 Mar 25; 15:31.
Competing interests: None declared
Show Less

Competing Interests: None declared.