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• W1520571424 abstract "To the Editor: We thank Lertxundi et al. for their comments1 on our recent article.2 We agree with their comments regarding inconsistencies assessing anticholinergic burden because of the discrepancies between scales. We also agree that the lack of agreement between scales is problematic, but there is no simple solution. Most anticholinergic drug lists are based on expert opinion with subsequent validation in people,3 but different groups of experts inevitably have different opinions about which medicines have high and low anticholinergic potency. In addition, different anticholinergic medicines are available in different settings. As Lertxundi et al.4 have previously highlighted, it is necessary to adapt anticholinergic scales for local settings if the scales have been developed elsewhere. This is what we did for our study by combining medicines from the Anticholinergic Risk Scale (ARS), Anticholinergic Drug Scale (ADS), and Drug Burden Index (DBI) to include anticholinergic medicines commonly used in Australia and to exclude those that are unavailable or not subsidized. When we commenced our study, a systematic review by Duran et al.3 had not been published, so we were unable to adapt this resource for use in our setting. The criteria for inclusion of anticholinergic medicines in our study were that they were on the ARS, ADS, or DBI and that they were available in Australia and subsidized on the national medicines subsidy scheme. Hyoscine was omitted because it is only subsidized for individuals receiving palliative care, and these individuals were excluded from our study. Although subsidized in Australia, clozapine is classified as a highly specialized drug dispensed from hospital pharmacies, so complete dispensing data are not available. The median age of our study population was 83, so use of clozapine and other medicines subsidized only for schizophrenia is likely to be uncommon.5 The sensitivity analysis in our study showed that excluding antipsychotic medicines did not change the findings.2 Developing a consistent tool to measure anticholinergic burden is important, but it will be difficult to develop a tool that is valid and applicable across multiple settings. Our study has demonstrated that the anticholinergic medicines included in our study are associated with risk of hospital admission for confusion, delirium, or dementia. Regardless of the anticholinergic scale used, this is an important finding that adds to the evidence base for negative cognitive effects associated with anticholinergic medicines. Conflict of Interest: The authors have no conflicts of interest to declare. This research was funded by the Australian Government Department of Veterans’ Affairs as part of the delivery of the Veterans’ Medicines Advice and Therapeutics Education Services project. Author Contributions: Kalisch Ellett, Pratt: study design, drafting the manuscript. Ramsay: study design, data analysis. Barratt, Roughead: study design, critical revision of manuscript for important intellectual content; study design of the and critically revised the manuscript for important intellectual content. All authors: reading and approval of final manuscript. Sponsor's Role: The Australian Government Department of Veterans’ Affairs reviewed this manuscript before submission but played no role in the design, execution, analysis, or interpretation of data or writing of the paper." @default.
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• W1520571424 date "2015-05-01" @default.
• W1520571424 modified "2023-09-25" @default.
• W1520571424 title "Response to Lertxundi and Colleagues" @default.
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• W1520571424 doi "https://doi.org/10.1111/jgs.13418" @default.
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