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The anticholinergic effect on cognition (AEC) scale: Associations with mortality, hospitalisation and cognitive decline following dementia diagnosis
Author(s) -
Bishara Delia,
Perera Gayan,
Harwood Daniel,
Taylor David,
Sauer Justin,
Stewart Robert,
Mueller Christoph
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.039357
Subject(s) - dementia , anticholinergic , cognition , medicine , cognitive decline , hazard ratio , anticholinergic agents , mini–mental state examination , psychiatry , pediatrics , gerontology , disease , confidence interval
Objectives To investigate associations between central anticholinergic burden (using the AEC scale), and mortality, hospitalisation and cognitive decline in patients with dementia. Methods The South London and Maudsley NHS Foundation Trust (SLaM) Clinical Records Interactive Search (CRIS) application was used to identify patients 65 years or older at their first recorded diagnosis of dementia. Data were linked to national mortality and hospitalisation sources, and serially recorded Mini‐Mental State Examination (MMSE) scores were used to investigate cognitive decline over the 36 months after diagnosis in mixed models. Results Patients for whom a review of their medication was indicated (AEC score ≥ 2 for any individual drug or total AEC score ≥ 3) had an increased risk of mortality (hazard ratio 1.07; 95% CI 1.01‐1.15) and emergency hospitalisation (1.10; 95% CI 1.04‐1.17), but there were no associations with duration of hospitalisation. Cognitive trajectory analyses showed that this exposure group had lower MMSE scores at diagnosis and a sharper increase in MMSE scores over the subsequent 6 months, but similar slopes for the 6‐36 months period to the remainder of the sample. Conclusions Patients with dementia receiving medication with high central anticholinergic activity (as measured on the AEC scale), appear to have worse prognosis in terms of mortality and hospitalisation risk, but have primarily acutely impaired cognitive function, rather than longer term differences in cognitive decline.