Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland.
Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University Hospital and University of Lausanne, Lausanne, Switzerland.
Eur J Clin Pharmacol. 2021 Feb;77(2):147-162. doi: 10.1007/s00228-020-02994-x. Epub 2020 Oct 3.
Older people are at risk of anticholinergic side effects due to changes affecting drug elimination and higher sensitivity to drug's side effects. Anticholinergic burden scales (ABS) were developed to quantify the anticholinergic drug burden (ADB). We aim to identify all published ABS, to compare them systematically and to evaluate their associations with clinical outcomes.
We conducted a literature search in MEDLINE and EMBASE to identify all published ABS and a Web of Science citation (WoS) analysis to track validation studies implying clinical outcomes. Quality of the ABS was assessed using an adapted AGREE II tool. For the validation studies, we used the Newcastle-Ottawa Scale and the Cochrane tool Rob2.0. The validation studies were categorized into six evidence levels based on the propositions of the Oxford Center for Evidence-Based Medicine with respect to their quality. At least two researchers independently performed screening and quality assessments.
Out of 1297 records, we identified 19 ABS and 104 validations studies. Despite differences in quality, all ABS were recommended for use. The anticholinergic cognitive burden (ACB) scale and the German anticholinergic burden scale (GABS) achieved the highest percentage in quality. Most ABS are validated, yet validation studies for newer scales are lacking. Only two studies compared eight ABS simultaneously. The four most investigated clinical outcomes delirium, cognition, mortality and falls showed contradicting results.
There is need for good quality validation studies comparing multiple scales to define the best scale and to conduct a meta-analysis for the assessment of their clinical impact.
老年人由于药物消除和对药物副作用更高敏感性的变化而面临抗胆碱能副作用的风险。抗胆碱能负担量表（ABS）旨在量化抗胆碱能药物负担（ADB）。我们旨在确定所有已发表的 ABS，对其进行系统比较，并评估它们与临床结局的相关性。
我们在 MEDLINE 和 EMBASE 中进行了文献检索，以确定所有已发表的 ABS，并通过 Web of Science 引文（WoS）分析来追踪涉及临床结局的验证研究。使用经过改编的 AGREE II 工具评估 ABS 的质量。对于验证研究，我们使用了 Newcastle-Ottawa 量表和 Cochrane 工具 Rob2.0。根据牛津循证医学中心的建议，将验证研究分为六个证据水平，以评估其质量。至少有两名研究人员独立进行了筛选和质量评估。
在 1297 条记录中，我们确定了 19 个 ABS 和 104 个验证研究。尽管质量存在差异，但所有 ABS 都被推荐使用。抗胆碱能认知负担（ACB）量表和德国抗胆碱能负担量表（GABS）在质量方面得分最高。大多数 ABS 都经过验证，但对于较新的量表，验证研究却缺乏。只有两项研究同时比较了 8 个 ABS。四个最受关注的临床结局——谵妄、认知、死亡率和跌倒——结果相互矛盾。
需要进行高质量的验证研究，比较多个量表以确定最佳量表，并对其临床影响进行荟萃分析。
