Objective: To determine the cumulative anticholinergic burden in Indian Parkinson’s disease (PD) patients and to correlate the same with cognitive impairment and gait disturbance.

Background: Long term use of anticholinergic drugs is associated with cognitive impairment, hallucinations, urinary retention and other adverse events, particularly in Parkinson’s disease (PD). Despite this, they are widely used in India. Commonly used non-PD medications may also have additional anticholinergic activity.

Method: We conducted a cross-sectional, observational study to identify the cumulative anticholinergic burden from drugs being taken by patients with PD. Two standard scales: Anticholinergic Cognitive Burden (ACB) scale and the newly created ACB score were used to calculate the individual anticholinergic burden from prescriptions. We identified the commonly prescribed drugs contributing to anticholinergic effects in the Indian scenario and correlated the total ACB score with patient reported cognitive impairment and gait parameters on MDS UPDRS-I, II and III.

Results: We recruited 289 PD patients (68.9% male) with mean age of 56.8±11.7 years and mean duration of symptoms 6.4±7.0 years. Patients were on a median of 4 (IQR = 4) medications. Median ACB score was 4 (range: 0 – 18). 177 (62.1%) patients had total ACB score >3. We identified 7 drugs with ACB score 3, 9 drugs with ACB score 2 and 17 drugs with ACB score 1 in this population. A higher total ACB score was associated with cognitive impairment (p=0.018) and freezing of gait (p=0.001).

Conclusion: Indian PD patients are exposed to significant anticholinergic burden both from drugs prescribed for PD and non-PD indications. Higher anticholinergic burden is associated with cognitive impairment and freezing of gait in PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/anticholinergic-burden-in-parkinsons-disease-patients-in-india-a-hospital-based-study/