215 - ECN Awards: Anticholinergic Burden: A Study in a Psychiatry of Later Life Cohort

Abstract

BackgroundMedications with anticholinergic activity are widely prescribed for a variety of medical,surgical, and psychiatric illnesses. There is strong evidence that the cumulativeanticholinergic properties of such medications (i.e., the anticholinergic burden) contributesto significant longer-term adverse effects, including dementia, impaired mobility, andincreased mortality. Despite this, the anticholinergic burden is often not given dueconsideration when cliniciansprescribe or review medications in routine clinical practice. Thisis of particularrelevance in services working with elderly patient populations, who are bothmore likely to experience polypharmacy and more vulnerable to medication adverse effects.Greater awareness of the risks of anticholinergic prescribing may lead to improvements inlonger-term cognitive and physical functioning,and subsequently decreased diseaseburden on individuals and society as a whole.Objectives/AimsTo identify and quantify anticholinergic burden among all patients currentlyattending a ruralPsychiatry of Later Life service.MethodsThis was a cross-sectional observational study. Chart reviews were carried out on all patientsopen to the service at the time of the study in November 2020. Each patient's medicationregime was analysed to calculate its overall score onthe Anticholinergic Effect on CognitionScale (AEC), using an online tool developed by South London and Maudsley NHS FoundationTrust. Other variables such as each patient's age, sex, and cognitive status (categorized as nocognitive impairment; mild cognitive impairment (MCI); or dementia) were also documented.Data was anonymised on collection. AEC scores of 2 or morewere deemed to be at thresholdfor 'review and withdraw or switch' of medications.ResultsA total of 80 patients were included in the study (48 female; mean age 77 [SD= 6.5] years). 45% of patients had a documented diagnosis of dementia, 11%had adocumented diagnosis of MCI and 44% had no documented cognitive impairment. Overall,the majority of patients (53.75%) were found to have an AEC score of 2 or greater (AEC range 0-6, mean 2.5 [SD = 1.5]). Of patients with a diagnosis of dementia, 58% were found to have anAEC of 2 or greater.ConclusionsThe possible detrimental effects of prescribed medication on cognition and physical health arelikely under-recognised in routine clinical practice. Greaterawareness of the anticholinergicproperties of a wide variety of commonly prescribed medication may lead to more selectiveand informed prescribing.Abstract has been accepted for a poster presentation at the British Association for PsychopharmacologySummer Meeting (July 2021), and at the European College of Neuropsychopharmacology AnnualCongress (October 2021).