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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Article info
Publication history
Published online: August 14, 2017
Accepted:
August 7,
2017
Received in revised form:
August 4,
2017
Received:
May 31,
2017
Identification
Copyright
© 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
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- An (Old) New Strategy to Manage BPSDThe American Journal of Geriatric PsychiatryVol. 26Issue 3
- PreviewThe 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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