Cognitive burden of anticholinergic medications in psychotic disorders

Seenae Eum, S. Kristian Hill, Leah H. Rubin, Ryan M. Carnahan, James L. Reilly, Elena I. Ivleva, Sarah K. Keedy, Carol A. Tamminga, Godfrey D. Pearlson, Brett A. Clementz, Elliot S. Gershon, Matcheri S. Keshavan, Richard S E Keefe, John A. Sweeney, Jeffrey R. Bishop

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Patients with psychotic disorders are often treated with numerous medications, many of which have anticholinergic activity. We assessed cognition in relation to the cumulative anticholinergic burden of multiple drugs included in treatment regimens of participants from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) study. Method: Clinically stable participants with schizophrenia (n = 206), schizoaffective disorder (n = 131), and psychotic bipolar disorder (n = 146) were examined. Anticholinergic properties of all scheduled drugs were quantified using the Anticholinergic Drug Scale (ADS). ADS scores were summed across individual drugs to create a total ADS burden score for each participant and examined in relation to the Brief Assessment of Cognition in Schizophrenia (BACS). Results: Anticholinergic burden aggregated across all medications was inversely related to cognitive performance starting at ADS scores of 4 in participants with schizophrenia. Those with ADS scores ≥. 4 had lower composite BACS scores compared to those with ADS. <. 4 (p = 0.004). Among BACS subtests, Verbal Memory was the most adversely affected by high anticholinergic burden. Despite similar anticholinergic burden scores across groups, a significant threshold effect of anticholinergic burden was not detected in schizoaffective or psychotic bipolar disorder. Conclusion: We identified an adverse effect threshold of anticholinergic burden on cognition in clinically stable participants with schizophrenia. This relationship was not identified in affective psychoses. Examination of other medications, doses, and clinical measures did not account for these findings. Patients with schizophrenia may have increased cognitive susceptibility to anticholinergic medications and the aggregate effects of one's medication regimen may be important to consider in clinical practice.

Original languageEnglish (US)
JournalSchizophrenia Research
DOIs
StateAccepted/In press - Jan 24 2017

Fingerprint

Cholinergic Antagonists
Psychotic Disorders
Schizophrenia
Cognition
Pharmaceutical Preparations
Bipolar Disorder
Psychotic Affective Disorders

Keywords

  • Anticholinergic medication burden
  • Cognitive impairments
  • Psychotic disorders

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

Eum, S., Hill, S. K., Rubin, L. H., Carnahan, R. M., Reilly, J. L., Ivleva, E. I., ... Bishop, J. R. (Accepted/In press). Cognitive burden of anticholinergic medications in psychotic disorders. Schizophrenia Research. https://doi.org/10.1016/j.schres.2017.03.034

Cognitive burden of anticholinergic medications in psychotic disorders. / Eum, Seenae; Hill, S. Kristian; Rubin, Leah H.; Carnahan, Ryan M.; Reilly, James L.; Ivleva, Elena I.; Keedy, Sarah K.; Tamminga, Carol A.; Pearlson, Godfrey D.; Clementz, Brett A.; Gershon, Elliot S.; Keshavan, Matcheri S.; Keefe, Richard S E; Sweeney, John A.; Bishop, Jeffrey R.

In: Schizophrenia Research, 24.01.2017.

Research output: Contribution to journalArticle

Eum, S, Hill, SK, Rubin, LH, Carnahan, RM, Reilly, JL, Ivleva, EI, Keedy, SK, Tamminga, CA, Pearlson, GD, Clementz, BA, Gershon, ES, Keshavan, MS, Keefe, RSE, Sweeney, JA & Bishop, JR 2017, 'Cognitive burden of anticholinergic medications in psychotic disorders', Schizophrenia Research. https://doi.org/10.1016/j.schres.2017.03.034
Eum, Seenae ; Hill, S. Kristian ; Rubin, Leah H. ; Carnahan, Ryan M. ; Reilly, James L. ; Ivleva, Elena I. ; Keedy, Sarah K. ; Tamminga, Carol A. ; Pearlson, Godfrey D. ; Clementz, Brett A. ; Gershon, Elliot S. ; Keshavan, Matcheri S. ; Keefe, Richard S E ; Sweeney, John A. ; Bishop, Jeffrey R. / Cognitive burden of anticholinergic medications in psychotic disorders. In: Schizophrenia Research. 2017.
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abstract = "Background: Patients with psychotic disorders are often treated with numerous medications, many of which have anticholinergic activity. We assessed cognition in relation to the cumulative anticholinergic burden of multiple drugs included in treatment regimens of participants from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) study. Method: Clinically stable participants with schizophrenia (n = 206), schizoaffective disorder (n = 131), and psychotic bipolar disorder (n = 146) were examined. Anticholinergic properties of all scheduled drugs were quantified using the Anticholinergic Drug Scale (ADS). ADS scores were summed across individual drugs to create a total ADS burden score for each participant and examined in relation to the Brief Assessment of Cognition in Schizophrenia (BACS). Results: Anticholinergic burden aggregated across all medications was inversely related to cognitive performance starting at ADS scores of 4 in participants with schizophrenia. Those with ADS scores ≥. 4 had lower composite BACS scores compared to those with ADS. <. 4 (p = 0.004). Among BACS subtests, Verbal Memory was the most adversely affected by high anticholinergic burden. Despite similar anticholinergic burden scores across groups, a significant threshold effect of anticholinergic burden was not detected in schizoaffective or psychotic bipolar disorder. Conclusion: We identified an adverse effect threshold of anticholinergic burden on cognition in clinically stable participants with schizophrenia. This relationship was not identified in affective psychoses. Examination of other medications, doses, and clinical measures did not account for these findings. Patients with schizophrenia may have increased cognitive susceptibility to anticholinergic medications and the aggregate effects of one's medication regimen may be important to consider in clinical practice.",
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AU - Ivleva, Elena I.

AU - Keedy, Sarah K.

AU - Tamminga, Carol A.

AU - Pearlson, Godfrey D.

AU - Clementz, Brett A.

AU - Gershon, Elliot S.

AU - Keshavan, Matcheri S.

AU - Keefe, Richard S E

AU - Sweeney, John A.

AU - Bishop, Jeffrey R.

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N2 - Background: Patients with psychotic disorders are often treated with numerous medications, many of which have anticholinergic activity. We assessed cognition in relation to the cumulative anticholinergic burden of multiple drugs included in treatment regimens of participants from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) study. Method: Clinically stable participants with schizophrenia (n = 206), schizoaffective disorder (n = 131), and psychotic bipolar disorder (n = 146) were examined. Anticholinergic properties of all scheduled drugs were quantified using the Anticholinergic Drug Scale (ADS). ADS scores were summed across individual drugs to create a total ADS burden score for each participant and examined in relation to the Brief Assessment of Cognition in Schizophrenia (BACS). Results: Anticholinergic burden aggregated across all medications was inversely related to cognitive performance starting at ADS scores of 4 in participants with schizophrenia. Those with ADS scores ≥. 4 had lower composite BACS scores compared to those with ADS. <. 4 (p = 0.004). Among BACS subtests, Verbal Memory was the most adversely affected by high anticholinergic burden. Despite similar anticholinergic burden scores across groups, a significant threshold effect of anticholinergic burden was not detected in schizoaffective or psychotic bipolar disorder. Conclusion: We identified an adverse effect threshold of anticholinergic burden on cognition in clinically stable participants with schizophrenia. This relationship was not identified in affective psychoses. Examination of other medications, doses, and clinical measures did not account for these findings. Patients with schizophrenia may have increased cognitive susceptibility to anticholinergic medications and the aggregate effects of one's medication regimen may be important to consider in clinical practice.

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