CUMULATIVE ANTICHOLINERGIC BURDEN AND ASSOCIATED OUTCOMES AMONG OLDER ADULTS WITH ALZHEIMER’S DISEASE
type: CreativeWork
description: Objectives: The objectives of this research were to (1) Evaluate the prevalence and predictors of cumulative anticholinergic burden among older adults with Alzheimer’s disease (AD) initiating Cholinesterase inhibitors (ChEIs); (2) Assess the risk of delirium associated with cumulative anticholinergic burden in older adults with AD; (3) Evaluate the treatment modification among older adults with AD after a delirium event. Methods: This study involved a new-user retrospective cohort study design using multi-year (2013-2017) Medicare claims data involving parts A, B, and D. The study sample included community-dwelling older adults (age 65 and older) with a diagnosis of AD initiating any of the ChEIs (donepezil, rivastigmine, or galantamine). The cumulative anticholinergic burden was calculated based on the Anticholinergic Cognitive Burden scale and patient-specific dosing using the defined daily dose over the defined period after ChEIs initiation. For objective 1, the dependent variable of interest for objective one was the cumulative anticholinergic burden levels, dichotomized into moderate-high (total standardized daily anticholinergic exposure (TSDD) over a year score ≥ 90) versus low-no (score 0–89). The primary outcome of interest for objective two was delirium, and the exposure of interest was the monthly cumulative anticholinergic burden, calculated as the monthly total standardized daily dose of medications with anticholinergic effects and categorized as no (0), low (1-10), moderate (11-40), and high (>40) burden. The primary outcome measures of interest for objective three were changes in trend and level of cumulative anticholinergic burden, sedative load, and opioid load and were measured as monthly burden/load calculated based on standardized dosing during a 12-month baseline and follow-up period among patients who had a delirium event compared with patients who did not have a delirium event (control group). The conceptual framework of the Andersen Behaviora…
abstract: Objectives: The objectives of this research were to (1) Evaluate the prevalence and predictors of cumulative anticholinergic burden among older adults with Alzheimer’s disease (AD) initiating Cholinesterase inhibitors (ChEIs); (2) Assess the risk of delirium associated with cumulative anticholinergic burden in older adults with AD; (3) Evaluate the treatment modification among older adults with AD after a delirium event. Methods: This study involved a new-user retrospective cohort study design using multi-year (2013-2017) Medicare claims data involving parts A, B, and D. The study sample included community-dwelling older adults (age 65 and older) with a diagnosis of AD initiating any of the ChEIs (donepezil, rivastigmine, or galantamine). The cumulative anticholinergic burden was calculated based on the Anticholinergic Cognitive Burden scale and patient-specific dosing using the defined daily dose over the defined period after ChEIs initiation. For objective 1, the dependent variable of interest for objective one was the cumulative anticholinergic burden levels, dichotomized into moderate-high (total standardized daily anticholinergic exposure (TSDD) over a year score ≥ 90) versus low-no (score 0–89). The primary outcome of interest for objective two was delirium, and the exposure of interest was the monthly cumulative anticholinergic burden, calculated as the monthly total standardized daily dose of medications with anticholinergic effects and categorized as no (0), low (1-10), moderate (11-40), and high (>40) burden. The primary outcome measures of interest for objective three were changes in trend and level of cumulative anticholinergic burden, sedative load, and opioid load and were measured as monthly burden/load calculated based on standardized dosing during a 12-month baseline and follow-up period among patients who had a delirium event compared with patients who did not have a delirium event (control group). The conceptual framework of the Andersen Behaviora…
author: TALWAR, ASHNA
language: eng
keywords: Cumulative anticholinergic burden, Alzheimer's Disease, Delirium, Medicare population
date published: 2023-08
date modified: 2026-07-24T02:32:47Z
provider: University of Houston
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: University of Houston

PropertyValue
property ID: Handle
value: https://hdl.handle.net/10657/15988