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). BPSD ratings on the NPI-NH, which assesses 12 domains of behavioral disturbance
in commonly seen in dementia, showed a significant reduction in frequency × severity
assessments. Of equal importance is the improvement in the Occupational Disruptiveness
scale. This is a global measure of the burden of BPSD on caregivers. Once again, frequency × severity
of reduction in BPSD diminished caregiver burden. Of note is the improvement in ability
to perform activities of daily living (ADLs) following anticholinergic burden (Jaidi
et al.
1
Table 2). Clinicians will easily appreciate that the performance of ADLs in institutional
settings is the activity often associated with worsening BPSD.To read this article in full you will need to make a payment
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References
- Reduction of the anticholinergic burden makes it possible to decrease behavioral and psychological symptoms of dementia.Am J Geriatr Psychiatry. 2018; 26: 280-288
- Cognitive behavioral and physiological changes in Alzheimers disease patients as a function of incontinence medications.Am J Geriatr Psychiatry. 2005; 13: 324-328
- Chronic exposure to anticholinergic medications adversely affects the course of Alzheimers disease.Am J Geriatr Psychiatry. 2003; 11: 358-361
- Anticholinergic medications might increase the risk of AD.Nat Rev Neurol. 2015; 11: 125
- Cumulative use of strung anticholinergics and incident dementia: a prospective cohort study.JAMA Intern Med. 2015; 175: 401-407
- Hypothesis of endogenous anticholinergic activity in Alzheimer's disease.Neurodegener Dis. 2015; 15: 149-156
Article info
Publication history
Published online: December 27, 2017
Accepted:
November 21,
2017
Received:
November 20,
2017
Identification
Copyright
© 2018 Published by Elsevier Inc. on behalf of American Association for Geriatric Psychiatry.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Reduction of the Anticholinergic Burden Makes It Possible to Decrease Behavioral and Psychological Symptoms of DementiaThe American Journal of Geriatric PsychiatryVol. 26Issue 3
- PreviewThe behavioral and psychological symptoms of dementia (BPSD) affect more than 90% of subjects during the development of Alzheimer disease (AD) and are similarly frequent in other types of dementia.1 BPSD are essentially noncognitive manifestations bringing about disorders that can affect mood, behavior, and perception.2 Their nature varies as a function of the etiologic diagnosis of the dementia,3 and they manifest at various stages of the neurodegenerative disease.4
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