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Brain structure and anticholinergic medication: Different results with different scales
Author(s) -
Kilimann Ingo,
Katharina Wittfeld,
Wucherer Diana,
Ittermann Till,
Voelzke Henry,
Bülow Robin,
Hoffmann Wolfgang,
Grabe Hans J.,
Teipel Stefan J.
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.039041
Subject(s) - anticholinergic , medicine , population , anticholinergic agents , cognition , brain size , physical therapy , psychology , psychiatry , magnetic resonance imaging , radiology , environmental health
Background Previous studies showed an inverse correlation between anticholinergic activity from individual medication and cognitive function. Various scales have been developed for scaling the anticholinergic effect of pharmacological substances. The Anticholinergic Cognitive Burden Scale (ACB) and the Anticholinergic Risk Scale (ARS) are the two most commonly used scales for this purpose. Our study evaluated the association of the ACB and the ARS total score with volumes of vulnerable brain structures for cognitive impairment (hippocampus [HIP] and basal forebrain [BF]) in non‐demented participants from a population‐based study. Methods We analyzed structural MRI and medication (n= 3,316) from participants (aged 20 to 93 years, 52.2% female) of the population‐based Study of Health in Pomerania (SHIP). Anticholinergic burden was obtained from the current medication plan using the ACB and the ARS scales, respectively. We added all scores per participant to an individual total score and evaluated the association with the volume of the HIP and the BF corrected for age, gender, education and total intracranial volume. In addition, we conducted voxel‐based morphometry analysis and compared the results to the volumetric analysis. Result We identified 1471 medications to be anticholinergic according to the ACB in a total of 706 participants and 446 medications according to the ARS in 188 participants. The volumetric analysis showed a statistically significant inverse association between the ACB and the volume of the HIP (left p=.0003, r=‐.54; right p=.00007, r=‐.59) but no correlation between the ACB total score and the BF volume (p=.070, r=‐.29). The analysis of the volumes of the HIP and the BF and the total ARS score did not show any statistically significant association in these structures (HIP left p=.431, r=+.12, HIP right p=.362, r=+.14, BF p=.055, r=+.28). Conclusion Several scores with different levels of comprehensiveness are available to calculate the individual anticholinergic burden. Our study showed that the more detailed ACB scoring revealed an association between the anticholinergic burden and the hippocampus whereas the ARS score with a limited number of substances did not show any statistically significant correlations. Further studies in independent samples and clinical follow‐up examinations are needed to better understand the potentials of the different scales.