Associations between Anticholinergic Burden and Adverse Health Outcomes in Parkinson Disease
Identifieur interne : 000435 ( Main/Exploration ); précédent : 000434; suivant : 000436Associations between Anticholinergic Burden and Adverse Health Outcomes in Parkinson Disease
Auteurs : James A. G. Crispo [Canada, États-Unis] ; Allison W. Willis [États-Unis] ; Dylan P. Thibault [États-Unis] ; Yannick Fortin [Canada] ; Harlen D. Hays [États-Unis] ; Douglas S. Mcnair [États-Unis] ; Lise M. Bjerre [Canada] ; Dafna E. Kohen [Canada] ; Santiago Perez-Lloret [Argentine] ; Donald R. Mattison [Canada] ; Daniel Krewski [Canada]Source :
- PLoS ONE [ 1932-6203 ] ; 2016.
English descriptors
- KwdEn :
- Accidental Falls (prevention & control), Adult, Aged, Aged, 80 and over, Cholinergic Antagonists (adverse effects), Cognition Disorders (chemically induced), Cognition Disorders (complications), Cohort Studies, Databases, Factual, Delirium (chemically induced), Delirium (complications), Emergency Service, Hospital, Female, Fractures, Bone (complications), Fractures, Bone (prevention & control), Hospitalization, Humans, Inpatients, Male, Middle Aged, Parkinson Disease (complications), Parkinson Disease (therapy), Proportional Hazards Models, Retrospective Studies, Risk Factors, Treatment Outcome.
- MESH :
- chemical , adverse effects : Cholinergic Antagonists.
- chemically induced : Cognition Disorders, Delirium.
- complications : Cognition Disorders, Delirium, Fractures, Bone, Parkinson Disease.
- prevention & control : Accidental Falls, Fractures, Bone.
- therapy : Parkinson Disease.
- Adult, Aged, Aged, 80 and over, Cohort Studies, Databases, Factual, Emergency Service, Hospital, Female, Hospitalization, Humans, Inpatients, Male, Middle Aged, Proportional Hazards Models, Retrospective Studies, Risk Factors, Treatment Outcome.
Abstract
Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on anticholinergic burden are limited in subpopulations, such as individuals with Parkinson disease (PD). The objective of this study was to determine whether anticholinergic burden was associated with adverse outcomes in a PD inpatient population.
Using the Cerner Health Facts® database, we retrospectively examined anticholinergic medication use, diagnoses, and hospital revisits within a cohort of 16,302 PD inpatients admitted to a Cerner hospital between 2000 and 2011. Anticholinergic burden was computed using the Anticholinergic Risk Scale (ARS). Primary outcomes were associations between ARS score and diagnosis of fracture and delirium. Secondary outcomes included associations between ARS score and 30-day hospital revisits.
Many individuals (57.8%) were prescribed non-PD medications with moderate to very strong anticholinergic potential. Individuals with the greatest ARS score (≥4) were more likely to be diagnosed with fractures (adjusted odds ratio (AOR): 1.56, 95% CI: 1.29–1.88) and delirium (AOR: 1.61, 95% CI: 1.08–2.40) relative to those with no anticholinergic burden. Similarly, inpatients with the greatest ARS score were more likely to visit the emergency department (adjusted hazard ratio (AHR): 1.32, 95% CI: 1.10–1.58) and be readmitted (AHR: 1.16, 95% CI: 1.01–1.33) within 30-days of discharge.
We found a positive association between increased anticholinergic burden and adverse outcomes among individuals with PD. Additional pharmacovigilance studies are needed to better understand risks associated with anticholinergic medication use in PD.
Url:
DOI: 10.1371/journal.pone.0150621
PubMed: 26939130
PubMed Central: 4777375
Affiliations:
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G." last="Crispo">James A. G. Crispo</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:aff id="aff002"><addr-line>Fulbright Canada Student, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Fulbright Canada Student, University of Pennsylvania, Philadelphia, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author><author><name sortKey="Willis, Allison W" sort="Willis, Allison W" uniqKey="Willis A" first="Allison W." last="Willis">Allison W. Willis</name><affiliation wicri:level="2"><nlm:aff id="aff003"><addr-line>Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff004"><addr-line>Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff005"><addr-line>Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author><author><name sortKey="Thibault, Dylan P" sort="Thibault, Dylan P" uniqKey="Thibault D" first="Dylan P." last="Thibault">Dylan P. Thibault</name><affiliation wicri:level="2"><nlm:aff id="aff003"><addr-line>Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff004"><addr-line>Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff005"><addr-line>Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author><author><name sortKey="Fortin, Yannick" sort="Fortin, Yannick" uniqKey="Fortin Y" first="Yannick" last="Fortin">Yannick Fortin</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Hays, Harlen D" sort="Hays, Harlen D" uniqKey="Hays H" first="Harlen D." last="Hays">Harlen D. Hays</name><affiliation wicri:level="2"><nlm:aff id="aff006"><addr-line>Cerner Corporation, Kansas City, Missouri, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Cerner Corporation, Kansas City, Missouri</wicri:regionArea><placeName><region type="state">Missouri (État)</region></placeName></affiliation></author><author><name sortKey="Mcnair, Douglas S" sort="Mcnair, Douglas S" uniqKey="Mcnair D" first="Douglas S." last="Mcnair">Douglas S. Mcnair</name><affiliation wicri:level="2"><nlm:aff id="aff006"><addr-line>Cerner Corporation, Kansas City, Missouri, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Cerner Corporation, Kansas City, Missouri</wicri:regionArea><placeName><region type="state">Missouri (État)</region></placeName></affiliation></author><author><name sortKey="Bjerre, Lise M" sort="Bjerre, Lise M" uniqKey="Bjerre L" first="Lise M." last="Bjerre">Lise M. Bjerre</name><affiliation wicri:level="1"><nlm:aff id="aff007"><addr-line>C. T. Lamont Primary Health Care Research Centre, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>C. T. Lamont Primary Health Care Research Centre, Department of Family Medicine, University of Ottawa, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff008"><addr-line>Bruyère Research Institute, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Bruyère Research Institute, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff009"><addr-line>School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Kohen, Dafna E" sort="Kohen, Dafna E" uniqKey="Kohen D" first="Dafna E." last="Kohen">Dafna E. Kohen</name><affiliation wicri:level="1"><nlm:aff id="aff009"><addr-line>School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Perez Lloret, Santiago" sort="Perez Lloret, Santiago" uniqKey="Perez Lloret S" first="Santiago" last="Perez-Lloret">Santiago Perez-Lloret</name><affiliation wicri:level="1"><nlm:aff id="aff010"><addr-line>Cardiology Research Institute, University of Buenos Aires, National Research Council (ININCA-UBA-CONICET), Buenos Aires, Argentina</addr-line></nlm:aff><country xml:lang="fr">Argentine</country><wicri:regionArea>Cardiology Research Institute, University of Buenos Aires, National Research Council (ININCA-UBA-CONICET), Buenos Aires</wicri:regionArea><wicri:noRegion>Buenos Aires</wicri:noRegion></affiliation></author><author><name sortKey="Mattison, Donald R" sort="Mattison, Donald R" uniqKey="Mattison D" first="Donald R." last="Mattison">Donald R. Mattison</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff011"><addr-line>Risk Sciences International, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Risk Sciences International, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Krewski, Daniel" sort="Krewski, Daniel" uniqKey="Krewski D" first="Daniel" last="Krewski">Daniel Krewski</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff011"><addr-line>Risk Sciences International, Ottawa, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Risk Sciences International, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Accidental Falls (prevention & control)</term><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Cholinergic Antagonists (adverse effects)</term><term>Cognition Disorders (chemically induced)</term><term>Cognition Disorders (complications)</term><term>Cohort Studies</term><term>Databases, Factual</term><term>Delirium (chemically induced)</term><term>Delirium (complications)</term><term>Emergency Service, Hospital</term><term>Female</term><term>Fractures, Bone (complications)</term><term>Fractures, Bone (prevention & control)</term><term>Hospitalization</term><term>Humans</term><term>Inpatients</term><term>Male</term><term>Middle Aged</term><term>Parkinson Disease (complications)</term><term>Parkinson Disease (therapy)</term><term>Proportional Hazards Models</term><term>Retrospective Studies</term><term>Risk Factors</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Cholinergic Antagonists</term></keywords><keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Cognition Disorders</term><term>Delirium</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Cognition Disorders</term><term>Delirium</term><term>Fractures, Bone</term><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Accidental Falls</term><term>Fractures, Bone</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Cohort Studies</term><term>Databases, Factual</term><term>Emergency Service, Hospital</term><term>Female</term><term>Hospitalization</term><term>Humans</term><term>Inpatients</term><term>Male</term><term>Middle Aged</term><term>Proportional Hazards Models</term><term>Retrospective Studies</term><term>Risk Factors</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on anticholinergic burden are limited in subpopulations, such as individuals with Parkinson disease (PD). The objective of this study was to determine whether anticholinergic burden was associated with adverse outcomes in a PD inpatient population.</p></sec><sec id="sec002"><title>Methods</title><p>Using the Cerner Health Facts® database, we retrospectively examined anticholinergic medication use, diagnoses, and hospital revisits within a cohort of 16,302 PD inpatients admitted to a Cerner hospital between 2000 and 2011. Anticholinergic burden was computed using the Anticholinergic Risk Scale (ARS). Primary outcomes were associations between ARS score and diagnosis of fracture and delirium. Secondary outcomes included associations between ARS score and 30-day hospital revisits.</p></sec><sec id="sec003"><title>Results</title><p>Many individuals (57.8%) were prescribed non-PD medications with moderate to very strong anticholinergic potential. Individuals with the greatest ARS score (≥4) were more likely to be diagnosed with fractures (adjusted odds ratio (AOR): 1.56, 95% CI: 1.29–1.88) and delirium (AOR: 1.61, 95% CI: 1.08–2.40) relative to those with no anticholinergic burden. Similarly, inpatients with the greatest ARS score were more likely to visit the emergency department (adjusted hazard ratio (AHR): 1.32, 95% CI: 1.10–1.58) and be readmitted (AHR: 1.16, 95% CI: 1.01–1.33) within 30-days of discharge.</p></sec><sec id="sec004"><title>Conclusions</title><p>We found a positive association between increased anticholinergic burden and adverse outcomes among individuals with PD. 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Coelho</name></author><author><name sortKey="Perez Lloret, S" uniqKey="Perez Lloret S">S Perez-Lloret</name></author><author><name sortKey="Fox, Sh" uniqKey="Fox S">SH Fox</name></author><author><name sortKey="Katzenschlager, R" uniqKey="Katzenschlager R">R Katzenschlager</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Argentine</li><li>Canada</li><li>États-Unis</li></country><region><li>Missouri (État)</li><li>Pennsylvanie</li></region></list><tree><country name="Canada"><noRegion><name sortKey="Crispo, James A G" sort="Crispo, James A G" uniqKey="Crispo J" first="James A. G." last="Crispo">James A. G. Crispo</name></noRegion><name sortKey="Bjerre, Lise M" sort="Bjerre, Lise M" uniqKey="Bjerre L" first="Lise M." last="Bjerre">Lise M. Bjerre</name><name sortKey="Bjerre, Lise M" sort="Bjerre, Lise M" uniqKey="Bjerre L" first="Lise M." last="Bjerre">Lise M. Bjerre</name><name sortKey="Bjerre, Lise M" sort="Bjerre, Lise M" uniqKey="Bjerre L" first="Lise M." last="Bjerre">Lise M. Bjerre</name><name sortKey="Fortin, Yannick" sort="Fortin, Yannick" uniqKey="Fortin Y" first="Yannick" last="Fortin">Yannick Fortin</name><name sortKey="Kohen, Dafna E" sort="Kohen, Dafna E" uniqKey="Kohen D" first="Dafna E." last="Kohen">Dafna E. Kohen</name><name sortKey="Krewski, Daniel" sort="Krewski, Daniel" uniqKey="Krewski D" first="Daniel" last="Krewski">Daniel Krewski</name><name sortKey="Krewski, Daniel" sort="Krewski, Daniel" uniqKey="Krewski D" first="Daniel" last="Krewski">Daniel Krewski</name><name sortKey="Mattison, Donald R" sort="Mattison, Donald R" uniqKey="Mattison D" first="Donald R." last="Mattison">Donald R. Mattison</name><name sortKey="Mattison, Donald R" sort="Mattison, Donald R" uniqKey="Mattison D" first="Donald R." last="Mattison">Donald R. Mattison</name></country><country name="États-Unis"><region name="Pennsylvanie"><name sortKey="Crispo, James A G" sort="Crispo, James A G" uniqKey="Crispo J" first="James A. G." last="Crispo">James A. G. Crispo</name></region><name sortKey="Hays, Harlen D" sort="Hays, Harlen D" uniqKey="Hays H" first="Harlen D." last="Hays">Harlen D. Hays</name><name sortKey="Mcnair, Douglas S" sort="Mcnair, Douglas S" uniqKey="Mcnair D" first="Douglas S." last="Mcnair">Douglas S. Mcnair</name><name sortKey="Thibault, Dylan P" sort="Thibault, Dylan P" uniqKey="Thibault D" first="Dylan P." last="Thibault">Dylan P. Thibault</name><name sortKey="Thibault, Dylan P" sort="Thibault, Dylan P" uniqKey="Thibault D" first="Dylan P." last="Thibault">Dylan P. Thibault</name><name sortKey="Thibault, Dylan P" sort="Thibault, Dylan P" uniqKey="Thibault D" first="Dylan P." last="Thibault">Dylan P. Thibault</name><name sortKey="Willis, Allison W" sort="Willis, Allison W" uniqKey="Willis A" first="Allison W." last="Willis">Allison W. Willis</name><name sortKey="Willis, Allison W" sort="Willis, Allison W" uniqKey="Willis A" first="Allison W." last="Willis">Allison W. Willis</name><name sortKey="Willis, Allison W" sort="Willis, Allison W" uniqKey="Willis A" first="Allison W." last="Willis">Allison W. Willis</name></country><country name="Argentine"><noRegion><name sortKey="Perez Lloret, Santiago" sort="Perez Lloret, Santiago" uniqKey="Perez Lloret S" first="Santiago" last="Perez-Lloret">Santiago Perez-Lloret</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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