Anticholinergic medication burden amongst patients with parkinsonism in the PRIME-UK cross-sectional study.

Introduction <br/>Medications with anticholinergic effects are widely prescribed for a variety of indications, including for overactive bladder symptoms. Side effects include constipation and dry mouth, whilst they have been associated with adverse outcomes including impaired cognition, falls and increased mortality. Since patients with Parkinson’s disease (PD) may be especially vulnerable to these negative effects, there is a need to understand prescribing practices in a representative sample. <br/><br/><br/>Methods <br/>We conducted a single-centre cross-sectional study with effort given to recruiting typically under-represented individuals with PD, including those with impaired capacity to consent who were supported by a consultee. Patients or their representative self-reported their medications. The Anticholinergic Cognitive Burden (ACB) scale [1,2] was used to assign drugs with anticholinergic properties a score between 1 to 3, generating a total score, where a score of 3 or more is considered clinically relevant. <br/><br/><br/>Results <br/>477 patients completed questionnaires (mean age 76.9 ± 8.5 years, 65% male). 152 (95% CI 28-36%) were on at least one anticholinergic medication, 56 (95% CI 9-15%) on an ACB score 3 medication, and 64 (95% CI 10-17%) had a total ACB score of 3 or more. 28 (95% CI 4-8%) were prescribed a medication with anticholinergic properties alongside a cognitive-enhancing medication. Cardiac medications (28%), analgesics (13%), antidepressants (13%) and urinary medications (12%) were the most frequent categories of medication with anticholinergic effects. <br/><br/><br/>Key conclusions <br/>Medications with anticholinergic effect are commonly prescribed to people with PD. It is important to review anticholinergic burden in these patients and to deprescribe where possible.