Clinical features and medicines contributing to cumulative anticholinergic cognitive burden among geriatric patients: A hospital-based retrospective study

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Background: Cumulative anticholinergic cognitive burden (ACB) is substantial for older patients. Objectives: The study aimed to determine the clinical features and medicines contributing to ACB among critically ill geriatric patients. Methods: A retrospective cohort study included 333 critically ill older patients at a geriatric hospital in Egypt. Reviewing of medical records was conducted. Charlson comorbidity index and hospital length of stay (LOS) were calculated. Laboratory parameters were checked with observation of multidrug-resistant (MDR) bacterial infections. Medications records were reviewed. Anticholinergics were defined and classified into light, moderate, and strong. On-line ACB calculator determined the cumulative ACB score. Statistical analyses were performed. Results: The mean age was 75.68 years. Median ACB score was 3. High ACB (ACB ≥3) occurred in 67.9% of the participants. Top ten anticholinergics included omeprazole, ipratropium, clindamycin, fentanyl, hydrocortisone, ampicillin, dexamethasone, digoxin, vancomycin, and tramadol. Combination of light anticholinergics represented 91.3% of prescriptions. High ACB was associated with male gender (odds ratio [OR] 1.877, P = 0.012), LOS (OR 1.145, P < 0.001), chronic lung disease (CLD) (OR 2.871, P = 0.006), and MDR infections (OR 4.060, P < 0.001). Significant admission diagnoses included respiratory insufficiency (OR 1.847, P = 0.017), acute kidney injury, (OR 0.308, P = 0.006), and acute stroke (OR 8.076, P = 0.044). Predictors of high ACB were male gender (OR 2.218, P = 0.022), LOS (OR 1.152, P < 0.001), and CLD (OR 3.298, P = 0.024). Conclusion: High cumulative ACB is common among older patients and mostly attributed to the combination of light anticholinerics. The study revealed its predictors and culprit medications.