Joined in 2023 
82 
63 About this deal
Nishtala PS, McLachlan AJ, Bell JS, Chen TF. Determinants of antipsychotic medication use among older people living in aged care homes in Australia. Int J Geriatr Psychiatry. 2010;25(5):449–57. Sixteen studies satisfied the inclusion criteria from an initial 496 studies. Fifteen studies identified a significant negative association of anticholinergic burden with mobility measures. One study did not find an association between anticholinergic intervention and mobility measures. Five studies included in the meta-analyses showed that anticholinergic burden significantly decreased walking speed (0.079 m/s ± 0.035 MD ± SE,95% CI: 0.010 to 0.149, p = 0.026), whilst a meta-analysis of four studies showed that anticholinergic burden significantly decreased physical function as measured by three variations of the Instrumental Activities of Daily Living (IADL) instrument 0.27 ± 0.12 (SMD ± SE,95% CI: 0.03 to 0.52), p = 0.027. The results of both meta-analyses had an I 2 statistic of 99% for study heterogeneity. Egger’s test did not reveal publication bias. Conclusion Substances such as mephedrone, spice, GBL or GHB, salvia and other emerging substances are collectively known as new psychoactive substances (NPS), often previously referred to as "legal highs". These substances are usually intended to mimic the effects of "traditional" drugs such as cannabis, ecstasy, or cocaine and can come in different forms such as herbal mixtures that are smoked, powders, crystals, tablets, or liquids. Frequent drug user
Gnjidic D, Cumming RG, Le Couteur DG, Handelsman DJ, Naganathan V, Abernethy DR, et al. Drug Burden Index and physical function in older Australian men. Br J Clin Pharmacol. 2009;68(1):97–105. The number of deaths in Scotland where benzodiazepines were implicated in or potentially contributed to the cause of death has increased markedly over the past 3 years, from 191 deaths registered in 2015 to 792 deaths in 2018. Most of this increase is due to ‘street’ benzodiazepines, mainly etizolam. Benzodiazepines were mentioned on the death certificate in 60% of DRDs registered in Northern Ireland in 2018. Ancelin ML, Artero S, Portet F, et al (2006) Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ. doi: 10.1136/bmj.38740.439664.DE.of adults aged 16 to 59 years had taken a Class A drug in the last year (approximately 881,000); a fall of 22% compared with 3.4% in the year ending March 2020
The citation analysis of individual scales revealed that ACB scale by Boustani et al. [ 24] was the most frequently validated expert based anticholinergic scale on adverse outcomes (N=13) followed by ARS [ 19] (N=11], ADS by Carnahan et al. [ 9] (N=9), CrAS scale by Han et al. [ 22] (N=3) and 2 other scales [ 23, 26]. The review found only two RCTs that showed an association with higher anticholinergic burden and adverse outcomes. The RCT that used the CrAS scale to quantify anticholinergic burden showed a positive association with functional outcome and quality of life and the RCT using the ADS scale reported a negative association with cognitive functioning. The adverse outcomes reported in the cohort studies included mainly cognitive and physical outcomes. The cognitive outcomes reported included mild-cognitive impairment, confusion, dizziness, falls, delirium, psychomotor speed and executive function. The functional outcomes reported were pertaining to activity of daily living, instrumental activity of daily living, quality of life, physical function, hospitalisation, length of hospital stay, and mortality. A detailed summary of validated studies for individual anticholinergic scales with critical appraisal is illustrated in Table 3. With increasing age comes age-related comorbidities that may be influenced by lifestyle, genomic makeup and other demographic factors. The increasing number of health issues require multiple medications (polypharmacy) to treat them. A 2005 study found that as of 2002, older adults defined as ≥ 65 years comprised 12% of the population of the United States but constituted 33% of its prescription drug expenditure (50 billion dollars) [ 1]. Whilst polypharmacy may be beneficial in treating underlying health conditions in older adults, it increases the risk of adverse drug events. In particular, taking multiple drugs with anticholinergic effects increases the risk of anticholinergic burden (AB) in older adults because of age-related pharmacokinetic and pharmacodynamic changes [ 2]. A systematic literature search was conducted across five electronic databases, EMBASE, CINAHL, PSYCHINFO, Cochrane CENTRAL and MEDLINE, from inception to December 2021, to identify studies on the association of anticholinergic burden with mobility. The search was performed following a strategy that converted concepts in the PECO elements into search terms, focusing on terms most likely to be found in the title and abstracts of the studies. For observational studies, the risk of bias was assessed using the Newcastle Ottawa Scale, and the Cochrane risk of bias tool was used for randomised trials. The GRADE criteria was used to rate confidence in evidence and conclusions. For the meta-analyses, we explored the heterogeneity using the Q test and I 2 test and the publication bias using the funnel plot and Egger’s regression test. The meta-analyses were performed using Jeffreys’s Amazing Statistics Program (JASP). ResultsThirteen per cent of people starting drug treatment in Great Britain in 2018 reported primary use of powder cocaine. There has been a notable increase in the proportion of people starting treatment for powder cocaine use in Scotland and Wales in recent years. Kalisch Ellett LM, Pratt NL, Ramsay EN, Barratt JD, Roughead EE. Multiple anticholinergic medication use and risk of hospital admission for confusion or dementia. J Am Geriatr Soc. 2014;62(10):1916–22. The first survey was conducted from March 2016 to September 2017 and assessed the average harm of 33 substances in in 5 dimensions (physical harm to users, psychological harm to users, social harm to users, physical and psychological harm to others, and social harm to others). As shown in Supplementary Figure 1, these dimensions were defined by 16 criteria, which have been validated in several studies of this type ( 5, 9, 10) (see Supplementary Materials—Methods Section). Overall harm to users and overall harm to others comprised 3 (physical, psychological, social) dimensions and 2 (physical & psychological, social) dimensions, respectively (for details see Supplementary Figure 1). The assessments were carried out using 5-point scales (from “not harmful” to “extremely harmful”).
In conclusion, there is not one standardised tool for measuring anticholinergic burden. Cohort studies have shown that higher anticholinergic burden is associated with negative brain effects, poorer cognitive and functional outcomes. We excluded articles in languages other than English, as well as case reports, commentaries, letters and editorials from the primary search and citation analysis. Anticholinergic rating scales based predominantly on serum anticholinergic activity (SAA) were also excluded from the review.A systematic review was conducted to assess the effectiveness of anticholinergic burden scales in predicting adverse outcomes in older individuals. This is particularly relevant as the anticholinergic burden has been associated with negative outcomes in aging populations. Salahudeen MS, Duffull SB, Nishtala PS. (2015) Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr. doi: 10.1186/s12877-015-0029-9. for Psychiatry, Psychotherapy, Psychosomatics and Neurology, Evangelische Stiftung Tannenhof, Remscheid, Germany There has been an increase in the prevalence of 15 year olds in England who have used benzodiazepines at some time in their life, from 0.5% in 2014 to 1.7% in 2018. Prevalence has also risen in Scotland, from 1.7% in 2015 to 2.8% in 2018. This has coincided with reports of increased alprazolam use (‘Xanax’) among school children. 4.4 MDMA and ecstasy
Great Deal 
New Comment