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Reduction of the Anticholinergic Burden Makes It Possible to Decrease Behavioral and Psychological Symptoms of Dementia

Published:August 14, 2017DOI:https://doi.org/10.1016/j.jagp.2017.08.005

      Highlights

      • Reducing the anticholinergic burden makes it possible to decrease frequency and severity of BPSD among elderly people with dementia.
      • Reducing the anticholinergic burden in relatively autonomous subjects (ADL ≥ 3) brings about a reduction of the occupational disruptiveness of the BPSD on the caregivers.
      • Anticholinergic burden could participate in the occurrence or the maintenance of the BPSD, and could thus constitute a potential avoidable cause.

      Objective

      The aim of this study was to evaluate the impact of a reduction of the anticholinergic burden (AB) on the frequency and severity of behavioral and psychological symptoms of dementia (BPSD) and their repercussions on the care team (occupational disruptiveness).

      Methods

      In this prospective, single-center study in an acute care unit for Alzheimer disease (AD) and related disorders, 125 elderly subjects (mean age: 84.4 years) with dementia presented with BPSD. The reduction of the AB was evaluated by the Anticholinergic Cognitive Burden Scale. BPSD were evaluated with the Neuropsychiatric Inventory–Nursing Home Version (NPI-NH). The effect of the reduction of the AB on the BPSD was studied using logistic regression adjusting for the variables of the comprehensive geriatric assessment.

      Results

      Seventy-one subjects (56.8%) presenting with probable AD, 32 (25.6%) mixed dementia (AD and vascular), 17 (13.6%) vascular dementia, and 5 (4.0%) Lewy body dementia were included. Reducing the AB by at least 20% enabled a significant decrease in the frequency × severity scores of the NPI-NH (adjusted odds ratio: 3.5; 95% confidence interval: 1.6–7.9) and of the occupational disruptiveness score (adjusted odds ratio: 9.9; 95% confidence interval: 3.6–27.3).

      Conclusion

      AB reduction in elderly subjects with dementia makes is possible to reduce BPSD and caregiver burden. Recourse to treatments involving an AB must be avoided as much as possible in these patients, and preferential use of nonpharmacologic treatment management plans is encouraged.

      Key Words

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      Linked Article

      • An (Old) New Strategy to Manage BPSD
        The American Journal of Geriatric PsychiatryVol. 26Issue 3
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          The report by Jaidi et al.1 in this issue of The American Journal of Geriatric Psychiatry should be given your fullest attention. It is an important study showing the negative effect of cumulative anticholinergic exposure (or anticholinergic burden) on those living with dementia. In 125 patients living with dementia, a modest 20% reduction (achieved in 67% of subjects) in total anticholinergic burden resulted in significant improvements in standard measures of behavioral and psychological symptom of dementia (BPSD).
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