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Anticholinergics May Carry Significant Cognitive and Gait Burden in Parkinson's Disease
Author(s) -
Rajan Roopa,
Saini Arti,
Verma Bhawna,
Choudhary Nishu,
Gupta Anu,
Vishnu Venugopalan Y.,
Bhatia Rohit,
Singh Mamta B.,
Srivastava Achal K.,
Srivastava Madakasira Vasantha Padma
Publication year - 2020
Publication title -
movement disorders clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.754
H-Index - 18
ISSN - 2330-1619
DOI - 10.1002/mdc3.13032
Subject(s) - anticholinergic , odds ratio , medicine , confidence interval , rating scale , cohort , anticholinergic agents , physical therapy , cognition , movement disorders , disease , psychology , psychiatry , developmental psychology
Background Anticholinergic drugs are associated with significant cognitive and other adverse events in older adults, including those with Parkinson's disease (PD). Anticholinergic effects are considered lesser in younger individuals and the burden and outcomes in younger patients with PD are unknown. Objectives To determine the cumulative anticholinergic burden in a cohort of younger of patients with PD and to correlate the same with cognitive impairment and freezing of gait (FOG). Methods We conducted a cross‐sectional study to identify the cumulative anticholinergic burden from medications prescribed to patients with PD. Two standard scales, the Anticholinergic Cognitive Burden (ACB) scale and the ACB score, were used to calculate the anticholinergic burden from prescriptions. We identified commonly prescribed drugs contributing to anticholinergic effects and correlated the cumulative ACB score with cognitive impairment (Movement Disorder Society–Unified Parkinson's Disease Rating Scale item 1.1) and FOG (Movement Disorder Society–Unified Parkinson's Disease Rating Scale items 2.13 and 3.11). Results We recruited 287 patients with PD (68.9% male) with a mean age of 56.9 ± 11.8 years and a duration of symptoms 6.3 ± 6.9 years. Median ACB score was 4 (range 0–12). A total of 164 (58.4%) patients had total ACB score > 3. ACB score > 3 was independently associated with cognitive impairment (Odds Ratio, 2.55; 95% confidence interval, 1.43–4.53; P < 0.001) and FOG using patient‐reported measures (Odds Ratio, 3.192; 95% Confidence Interval, 1.68–6.07; P < 0.001) and objective measures (odds ratio, 2.41; 95% confidence interval, 1.27–4.6, P = 0.007). Conclusion Patients with PD are exposed to significant anticholinergic burden from drugs prescribed for PD and non‐PD indications. Higher anticholinergic burden is associated with cognitive impairment and FOG even in younger patients with PD.