scholarly journals Anticholinergic Medication Use, Dopaminergic Genotype, and Recurrent Falls

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 756-756
Author(s):  
Andrea Rosso ◽  
Xiaonan Zhu ◽  
Zachary Marcum ◽  
Nico Bohnen ◽  
Briana Sprague ◽  
...  
Keyword(s):  
Generalized Estimating Equations ◽  
Fall Risk ◽  
Medication Use ◽  
Effect Modification ◽  
Anticholinergic Medication ◽  
Anticholinergic Medications ◽  
Recurrent Falls ◽  
Increase Risk ◽  
Dopamine Signaling

Abstract Anticholinergic medications (A-chol) increase risk for falls; higher dopaminergic signaling may provide resilience to these effects. In 2489 older adults (mean age=74; 52% women) with 10 years of data on medication use, falls, and dopaminergic genotype (catechol-O-methyltransferase (COMT)), we assessed the association of A-chol use with recurrent falls (≥2) over the subsequent 12 months using generalized estimating equations. Effect modification by COMT (met/met, higher dopamine signaling, n=473 vs val carriers, lower dopamine signaling, n=2016) was tested; analyses were then stratified by COMT and adjusted for demographics and A-chol use indicators. During follow-up, 843 people reported recurrent falls. A-chol use doubled the odds of recurrent falls (OR [95%CI]=2.13[1.74, 2.60]), with a suggested effect modification by COMT (p=0.1). The association was present in val carriers (adjusted OR [95%CI]=1.93[1.36, 2.73]) but not in met/met (adjusted OR [95%CI]=1.30[0.53, 3.22]). Higher dopaminergic signaling may provide protection against the effects of A-chol use on fall risk.

Anticholinergic Medication Use, Dopaminergic Genotype, and Recurrent Falls

2021 ◽  
Author(s):  
Andrea L Rosso ◽  
Zachary A Marcum ◽  
Xiaonan Zhu ◽  
Nicolaas Bohnen ◽  
Caterina Rosano
Keyword(s):  
Fall Risk ◽  
Medication Use ◽  
Effect Modification ◽  
Anticholinergic Medication ◽  
Anticholinergic Medications ◽  
Recurrent Falls ◽  
Health Aging ◽  
Dopamine Signaling

Abstract Background Anticholinergic medications are associated with fall risk. Higher dopaminergic signaling may provide resilience to these effects. We tested interactions between anticholinergic medication use and dopaminergic genotype on risk for recurrent falls over 10 years. Methods Participants in the Health, Aging, and Body Composition (Health ABC) study (n = 2 372, mean age = 73.6; 47.8% men; 60.0% White) without disability or anticholinergic use at baseline were followed for up to 10 years for falls. Medication use was documented in 7 of 10 years. Highly anticholinergic medications were defined by Beers criteria, 2019. Recurrent falls were defined as ≥2 in the 12 months following medication assessment. Generalized estimating equations tested the association of anticholinergic use with recurrent falls in the following 12 months, adjusted for demographics, health characteristics, and anticholinergic use indicators. Effect modification by dopaminergic genotype (catechol-O-methyltransferase [COMT]; Met/Met, higher dopamine signaling, n = 454 vs Val carriers, lower dopamine signaling, n = 1 918) was tested and analyses repeated stratified by genotype. Results During follow-up, 841 people reported recurrent falls. Anticholinergic use doubled the odds of recurrent falls (adjusted odds ratio [OR] [95% CI] = 2.09 [1.45, 3.03]), with suggested effect modification by COMT (p = .1). The association was present in Val carriers (adjusted OR [95% CI] = 2.16 [1.44, 3.23]), but not in Met/Met genotype (adjusted OR [95% CI] = 1.70 [0.66, 4.41]). Effect sizes were stronger when excluding baseline recurrent fallers. Conclusion Higher dopaminergic signaling may provide protection against increased 12-month fall risk from anticholinergic use. Assessing vulnerability to the adverse effects of anticholinergic medications could help in determination of risk/benefit ratio for prescribing and deprescribing anticholinergics in older adults.

scholarly journals Anticholinergic burden in middle-aged women and recurrent falls in later life: findings from the Aberdeen prospective osteoporosis screening study (APOSS)

2020 ◽  
Vol 11 ◽  
pp. 204209862092985
Author(s):  
Samuel R. Neal ◽  
Adrian D. Wood ◽  
Andrew D. Ablett ◽  
Jenny S. Gregory ◽  
Jordan Guillot ◽  
...  
Keyword(s):  
Middle Age ◽  
Later Life ◽  
Middle Aged ◽  
Initial Exposure ◽  
Osteoporosis Screening ◽  
Anticholinergic Medications ◽  
Recurrent Falls ◽  
Screening Study ◽  
Anticholinergic Burden

Background: Anticholinergic burden (ACB) is a recognised risk factor for falls in older people; however, whether ACB in middle age predicts falls in later life is unknown. Methods: We examined this association in the middle-aged women of the Aberdeen Prospective Osteoporosis Screening Study (APOSS). ACB was calculated at the second health visit (1997–1999, study baseline) using the Anticholinergic Cognitive Burden Scale. Outcomes were incidence of 1 fall and recurrent falls (⩾2 falls) during the 12 months prior to follow up 2007–2011. Multinomial logistic regression analyses adjusted for potential confounders including demographics, comorbidities and falls history. Results: A total of 2125 women {mean age (standard deviation [SD]): 54.7 (2.2) years at baseline and 66.0 (2.2) years at follow up} were included. Prevalence of baseline ACB score of 0, 1 and ⩾2 was 87.1%, 7.3% and 5.6%, respectively. Compared with no ACB, ACB ⩾2 was associated with recurrent falls in the previous 12 months [adjusted odds ratio (OR): 2.34, 95% confidence interval (CI): 1.31, 4.19] at an average of 11 years after initial exposure. No such association was found for an ACB score of 1. Conclusions: These findings highlight the potential negative effects of anticholinergic medications in middle age. While cautious use of anticholinergic medications is advisable, further longitudinal research should be conducted to confirm these findings before any specific clinical recommendations can be made.

scholarly journals P.019 Trends in medication use over eleven years in patients presenting to a rural and remote memory clinic

2016 ◽  
Vol 43 (S2) ◽  
pp. S25-S26
Author(s):  
R Verity ◽  
A Kirk
Keyword(s):  
Medication Use ◽  
Significant Decline ◽  
Remote Memory ◽  
Anticholinergic Medication ◽  
Memory Clinic ◽  
Rural And Remote ◽  
Anticholinergic Medications ◽  
To Come ◽  
Spearman’S Correlation ◽  
Over Time

Background: Anticholinergic and sedating medications are generally contraindicated in those with cognitive decline. We examined trends in medication use by patients presenting to a rural and remote memory clinic (RRMC) between March 2004 and June 2015 to determine whether patterns of medication use have changed. Methods: The first 445 patients seen at the RRMC between 2004 and 2015 were included in this analysis. Medication lists were collected at the patient’s initial visit, and it was noted whether patients were taking anticholinergic or potentially sedating drugs. Statistical analysis (Spearman’s Correlation) was conducted to examine trends in medication use over time. Results: Ninety-one patients (20.5%) were taking at least one anticholinergic medication. There was a statistically significant decline (25.0% in 2004 to 12.5% in 2014) in percentage of patients presenting with anticholinergic medications over the eleven years of this study (Spearman’s correlation coefficient=-0.64, p=0.035). Conclusions: The most encouraging statistic to come from this study is a decline in anticholinergic medication use in this rural population. Prescribers must be properly informed to ensure that the number of medications per patient does not continue to rise, that medications are used only as necessary, and that potentially deleterious medications are avoided.

Anticholinergic medication use is associated with globus pharyngeus

2016 ◽  
Vol 130 (12) ◽  
pp. 1125-1129 ◽  
Author(s):  
S Haft ◽  
R M Carey ◽  
D Farquhar ◽  
N Mirza
Keyword(s):  
Medication Use ◽  
Cross Sectional Study ◽  
Anticholinergic Medication ◽  
Severity Scale ◽  
Cross Sectional ◽  
Globus Pharyngeus ◽  
Anticholinergic Medications ◽  
Considerable Portion ◽  
Previous Diagnosis ◽  
And Gender

AbstractBackground:Globus pharyngeus has been linked to salivary hypofunction. We hypothesise that a considerable portion of the globus experienced by patients is due to a drying effect secondary to anticholinergic medication use; this study aimed to determine their association.Methods:A cross-sectional study was conducted of 270 patients who presented to a laryngology practice over 6 months. Participants rated globus sensation on a 5-point severity scale, with those scoring 0 considered as controls (non-globus). Participants were excluded if they had a likely cause of globus. Scores were compared with participants’ medication lists, co-morbidities, age and gender, and evaluated using multivariate analysis, with significance set at p < 0.05.Results:Any participant taking at least 2 anticholinergic medications had a 3.52 increased odds (p = 0.02) of experiencing globus. A previous diagnosis of gastroesophageal reflux disease was also significantly associated with globus (p = 0.004), with an odds ratio of 3.75.Conclusion:A substantial portion of idiopathic globus may be due to anticholinergic use or reflux. The findings implicate medication use as a risk factor for globus. An awareness of these associations is invaluable for identifying cause and treating globus.

scholarly journals Reward Region Responsivity Predicts Future Weight Gain and Further Evidence that the TaqIA Allele Moderates these Predictive Effects

2017 ◽  
Author(s):  
Kyle Stanley Burger
Keyword(s):  
Weight Gain ◽  
Body Fat ◽  
Neural Response ◽  
Monetary Reward ◽  
Healthy Weight ◽  
Vulnerability Factors ◽  
Allele Status ◽  
Increase Risk ◽  
Dopamine Signaling

As no large prospective study has evaluated neural vulnerability factors that predict future weight gain we tested whether neural response to receipt and anticipated receipt of palatable food and monetary reward predicted weight gain over 3-year follow-up in originally healthy-weight adolescents and whether relations were moderated by the TaqIA polymorphism, which affects dopamine signaling capacity. 153 adolescent humans completed functional magnetic resonance imaging (fMRI) paradigms assessing response to these four events; body fat was assessed yearly over follow-up. Split half analyses indicated that elevated orbitofrontal cortex response to cues signaling impending milkshake receipt predicted future body fat gain (r = .32), which is a novel finding that provides support for the incentive sensitization theory of obesity. Neural response to receipt and anticipated receipt of monetary reward did not predict body fat gain, which has not been tested previously. Replicating an interaction reported previously (Stice et al., 2008a), elevated caudate response to milkshake receipt predicted future body fat gain for youth with a genetic propensity for greater dopamine signaling by virtue of possessing the TaqIA A2/A2 allele, but lower caudate response predicted body fat gain for youth with a genetic propensity for less dopamine signaling by virtue of possessing a TaqIA A1 allele, though this interaction was only marginal (pFWE = .06). Parental obesity, which correlated with TaqIA allele status (OR = 2.7), similarly moderated the predictive effects of caudate response to milkshake receipt to body fat gain, which is also a novel finding. The former interaction implies that too much or too little dopamine signaling capacity and reward region responsivity may increase risk for overeating, suggesting the possibility of qualitatively distinct reward surfeit and reward deficit pathways to obesity.

scholarly journals Trends in Medication Use Over 11 Years in Patients Presenting to a Rural and Remote Memory Clinic

2016 ◽  
Vol 43 (6) ◽  
pp. 815-818 ◽  
Author(s):  
Ryan Verity ◽  
Andrew Kirk ◽  
Debra Morgan ◽  
Chandima Karunanayake
Keyword(s):  
Medication Use ◽  
Remote Memory ◽  
Anticholinergic Medication ◽  
Memory Clinic ◽  
Rural And Remote ◽  
Anticholinergic Medications ◽  
The Central Nervous System ◽  
To Come ◽  
Spearman’S Correlation ◽  
Over Time

AbstractBackground: Anticholinergic and sedating medications are generally contraindicated in those with cognitive decline. We examined trends in medication use by patients at initial presentation to a rural and remote memory clinic (RRMC) between March 2004 and June 2015 to determine whether patterns of medication use have changed. Methods: The first 444 patients seen at the RRMC between 2004 and 2015 were included in this analysis. Medication lists were collected at the patient’s initial visit, and it was noted whether patients were taking anticholinergic or potentially sedating drugs. Statistical analysis (Spearman’s correlation) was conducted to examine trends in medication use over time. Results: Patients were on a mean of 5.18 medications (standard deviation, 3.46). Ninety-one patients (20.5%) were taking at least one anticholinergic medication. There was a decline (25.0% in 2004 to 12.5% in 2014) in percentage of patients presenting with anticholinergic medications over the 11 years of this study (Spearman’s correlation coefficient =−0.64, p=0.035). The prevalence of drugs acting on the central nervous system trended toward an increase, but this was not statistically significant. Sixty-three patients (14.2%) presented to the RRMC already taking a cholinesterase inhibitor. Conclusions: The most encouraging statistic to come from this study is a decline in anticholinergic medication use in this rural population. Prescribers must be properly informed to ensure that the number of medications per patient does not continue to rise, that medications are used only as necessary, and that potentially deleterious medications are avoided.

scholarly journals Incidence and multidimensional predictors of occasional and recurrent falls among Malaysian community‐dwelling older persons

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Theng Choon Ooi ◽  
Devinder Kaur Ajit Singh ◽  
Suzana Shahar ◽  
Nor Fadilah Rajab ◽  
Divya Vanoh ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Older Persons ◽  
Test Score ◽  
Community Dwelling ◽  
Chair Stand ◽  
Stand Test ◽  
Chair Stand Test ◽  
Recurrent Falls ◽  
History Of

Abstract Background Falls incidence rate and comprehensive data on factors that predict occasional and repeated falls from large population-based studies are scarce. In this study, we aimed to determine the incidence of falls and identify predictors of occasional and recurrent falls. This was done in the social, medical, physical, nutritional, biochemical, cognitive dimensions among community-dwelling older Malaysians. Methods Data from 1,763 Malaysian community-dwelling older persons aged ≥ 60 years were obtained from the LRGS-TUA longitudinal study. Participants were categorized into three groups according to the presence of a single fall (occasional fallers), ≥two falls (recurrent fallers), or absence of falls (non-fallers) at an 18-month follow-up. Results Three hundred and nine (17.53 %) participants reported fall occurrences at an 18-month follow-up, of whom 85 (27.51 %) had two or more falls. The incidence rate for occasional and recurrent falls was 8.47 and 3.21 per 100 person-years, respectively. Following multifactorial adjustments, being female (OR: 1.57; 95 % CI: 1.04–2.36), being single (OR: 5.31; 95 % CI: 3.36–37.48), having history of fall (OR: 1.86; 95 % CI: 1.19–2.92) higher depression scale score (OR: 1.10; 95 % CI: 1.02–1.20), lower hemoglobin levels (OR: 0.90; 95 % CI: 0.81-1.00) and lower chair stand test score (OR: 0.93; 95 % CI: 0.87-1.00) remained independent predictors of occasional falls. While, having history of falls (OR: 2.74; 95 % CI: 1.45–5.19), being a stroke survivor (OR: 8.57; 95 % CI: 2.12–34.65), higher percentage of body fat (OR: 1.04; 95 % CI: 1.01–1.08) and lower chair stand test score (OR: 0.87; 95 % CI: 0.77–0.97) appeared as recurrent falls predictors. Conclusions Having history of falls and lower muscle strength were predictors for both occasional and recurrent falls among Malaysian community-dwelling older persons. Modifying these predictors may be beneficial in falls prevention and management strategies among older persons.

Psychotropic medication use among personality disordered young adults. A follow-up study among former adolescent psychiatric inpatients

2020 ◽  
Vol 293 ◽  
pp. 113449
Author(s):  
Liisa Kantojärvi ◽  
Helinä Hakko ◽  
Milla Mukka ◽  
Anniina Käyhkö ◽  
Pirkko Riipinen ◽  
...  
Keyword(s):  
Young Adults ◽  
Psychotropic Medication ◽  
Medication Use ◽  
Psychiatric Inpatients ◽  
Follow Up Study ◽  
Personality Disordered

scholarly journals Psychotropic and pain medication use in individuals with traumatic brain injury—a Swedish total population cohort study of 240 000 persons

2021 ◽  
Vol 92 (5) ◽  
pp. 519-527
Author(s):  
Yasmina Molero ◽  
David James Sharp ◽  
Brian Matthew D'Onofrio ◽  
Henrik Larsson ◽  
Seena Fazel
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Total Population ◽  
Medication Use ◽  
Population Based ◽  
Pain Medication ◽  
Short Term ◽  
Pain Medications ◽  
Before And After

ObjectiveTo examine psychotropic and pain medication use in a population-based cohort of individuals with traumatic brain injury (TBI), and compare them with controls from similar backgrounds.MethodsWe assessed Swedish nationwide registers to include all individuals diagnosed with incident TBI between 2006 and 2012 in hospitals or specialist outpatient care. Full siblings never diagnosed with TBI acted as controls. We examined dispensed prescriptions for psychotropic and pain medications for the 12 months before and after the TBI.ResultsWe identified 239 425 individuals with incident TBI, and 199 658 unaffected sibling controls. In the TBI cohort, 36.6% had collected at least one prescription for a psychotropic or pain medication in the 12 months before the TBI. In the 12 months after, medication use increased to 45.0%, an absolute rate increase of 8.4% (p<0.001). The largest post-TBI increases were found for opioids (from 16.3% to 21.6%, p<0.001), and non-opioid pain medications (from 20.3% to 26.6%, p<0.001). The majority of prescriptions were short-term; 20.6% of those prescribed opioids and 37.3% of those with benzodiazepines collected prescriptions for more than 6 months. Increased odds of any psychotropic or pain medication were associated with individuals before (OR: 1.62, 95% CI: 1.59 to 1.65), and after the TBI (OR: 2.30, 95% CI: 2.26 to 2.34) as compared with sibling controls, and ORs were consistently increased for all medication classes.ConclusionHigh rates of psychotropic and pain medications after a TBI suggest that medical follow-up should be routine and review medication use.

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