Anticholinergic burden and polypharmacy in patients referred from primary care to tertiary dementia centers in Brazil

Carga anticolinérgica e polifarmácia em pacientes encaminhados da atenção primária para centros terciários de demência no Brasil

Anticholinergic burden (ACB) and polypharmacy are poorly studied in the context of primary care in Brazil.

Objective:  To evaluate the ACB and polypharmacy of individuals with suspected dementia referred from primary care to tertiary dementia outpatient clinics in Brazil.

Methods:  We performed a cross-sectional study in two tertiary dementia clinics. We included individuals with suspected dementia referred from primary care. Sociodemographic variables, number of drugs, ACB score, disease duration, Mini Mental State Examination (MMSE) were collected in the first evaluation. Final diagnosis received was also collected.

Results:  A total of 921 individuals were included, with a median (IQR) age of 72 [64–78] years, 57.8% (532) women, 4 [2–7] years of formal education and 15 [10–20] points in MMSE. Most patients had a final diagnosis of dementia (66%, 616) and Alzheimer’s disease (21.4%, 197), psychiatric disorders (16%, 147) and multifactorial dementia (14.8%, 136) were the most common diagnoses. Most individuals (68.1%, 627) were using at least one medication with anticholinergic effect, and in 44.6% (411) there was polypharmacy. ACB total score correlated with MMSE (rho=-0.13) and with total number of medications (rho=0.52). In multivariate regression, ACB score ≥1 was associated with MMSE and polypharmacy.

Conclusion:  Most individuals referred from primary care in Brazil were using at least one medication with anticholinergic effect and this was correlated with cognitive severity. Educational measures for primary care physicians, focusing on the management of pharmacological treatment, are essential to reduce the anticholinergic load in this context.

Keywords:
Polypharmacy; Dementia; Referral and Consultation; Primary Health Care