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Excluding HIV drugs, mean drug consumption was 2. The percentage of HIV patients aged 50 years or older who were taking anticholinergic agents was statistically significantly higher on the ACB scale than on the ARS scale.
No studies anticolnergicos available on the HIV population with which to compare our results, but there is evidence that this group of drugs can affect older adults. Determinar si consumen alguna benzodiacepina.
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Several factors underlie the increase in HIV infection rates in individuals 50 years or older: The parallel increase in the mean anticolimergicos of these patients causes a parallel increase in the frequency of non-AIDS related complications i. HIV and ageing may mutually reinforce their adverse effects on brain structure and function 4.
Cognitive disorders associated with HIV are very common during the ageing process, anticlinergicos since the introduction of HAART there has been a reduction in the incidence of most of the more severe forms of cognitive impairment 5.
The cognitive skills impaired by HIV include several domains, such as learning, memory, information processing speed, executive functions, and motor skills 6. Ageing is also garmacos with a greater susceptibility to the toxic effects of drugs and to drug-drug interactions. This risk is partly aggravated by the polypharmacy characteristic of this age group 4. Anticholinergic agents are widely used in current clinical practice for the treatment of such disparate entities as urinary incontinence, peptic ulcer, irritable bowel syndrome, depression, and tremor, or for sedation.
Despite their widespread use, adverse effects are relatively common 7. Thus, at the peripheral level, the most common adverse effects include decreased secretions, decreased intestinal motility, blurred vision, increased heart rate, and urinary retention 8. At the level of the central nervous system, due to the involvement of muscarinic receptors in mediating attention, learning, and short-term memory mechanisms, the use of anticholinergic agents can lead to a deterioration of cognitive function and even precipitate delirium 9.
The adverse effects of anticholinergic agents on the cognitive functions of these patients depend on total anticholinergic burden, baseline cognitive function, and individual pharmacokinetic and pharmacodynamic variability. The metabolism and excretion of these agents decrease with age. The ageing-associated reduction in brain cholinergic activity is another mechanism that increases the risk of exceeding the symptomatic threshold for the anticholinergic effect. Symptoms related to the anticholinergic effect are lack of concentration and memory loss and, in the case of people with cognitive deficits, the exacerbation of cognitive symptoms and functional deterioration, which leads to false diagnoses of dementia or mild cognitive impairment Therefore, the use of anticholinergic agents is considered inappropriate even in healthy older adults.
This situation is even more common in the setting of polypharmacy 7. Different scales are available to quantify the burden of the anticholinergic effect. These scales rank anticholinergic agents into 3 categories: However, there are differences between the 2 scales in the medications they include and in the way the medications are ranked. The Drug Burden Index DBI includes the dose of active ingredients, and is thus a good scale to measure anticholinergic burden The study objectives were: To determine the prevalence of anticholinergic agent consumption in HIV patients 50 years or older; to determine the anticholinergic risk of each patient using the ACB scale and the ARS; and to determine if these patients also use any type of benzodiazepine BZD.
A descriptive observational study reviewing all the treatments administered to HIV patients 50 years or older recorded by the Department of Epidemiological Surveillance and Control of Communicable Diseases of the Autonomous Community of La Rioja. The exclusion criteria were: Patients with a life expectancy of less than 3 months; or patients with no available primary and specialized care history. The study variables were: This study applied 2 of the most commonly used validated scales: Drugs included in these scales are classified according to their anticholinergic effect.
Each drug has a value of 1 to 3 anticlinergicos on its risk of causing anticholinergic effects, such as dry mouth, dry eyes, dizziness, confusion, constipation, or falls.
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The sum of the scores shows whether there is a decreased or increased risk of experiencing adverse anticholinergic effects. It must be noted that the consumption of several anticholinergic agents increases the risk of adverse events.
An anticolinergifos score of 1 represents a low level of risk, 2 represents a moderate risk, and 3 or more represents a high level of risk.
Qualitative data are expressed as absolute frequencies and percentages.
The study was conducted according to the recommendations of the Helsinki Declaration. All information was treated as confidential and exclusively used in a professional setting. Any personal data that allowed identification of the patient was managed according to data protection legislation.
The study participants were identified only by a code in all reports and data analyses. We reviewed the pharmacotherapeutic records of patients. Of the patients, In descending order, the HIV transmission route was: Mean drug consumption for conditions other than HIV was 2.
According to the ACB scale, Anticholinergic risk was low According to the ARS, It was found that The most commonly used BZDs were lorazepam and lormetazepam. The difference between scales was similar to that obtained in an Italian study that used the ARB scale and ARS in elderly inpatients One of the limitations of this study may be the lack of interviews with the patients.
Information on the prescribed medications was obtained from the medical record database used and may not correspond to what the patient actually takes each day. A further limitation is that no data on health outcomes were collected. No studies are available on HIV patients 50 years or older with which to compare the results on the use of anticholinergic agents. Published studies simply refer to risk in older adults 13 A published review established alternatives to the most commonly used anticholinergic agents to avoid their use 16and the Beers List recommended avoiding the use of a new drug with anticholinergic risk in older adults The Consensus Document on HIV and Aging recommended avoiding the use of potentially dangerous drugs such as anticholinergics, BZDs, and antidepressants in older patients The consumption of agents with higher anticholinergic risk and greater anticholinergic burden was greater on the ACB scale than on the ARS.
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Given these differences, the choice of using 1 scale over the other may present a challenge. On the ACB scale, the most commonly used agents with an anticholinergic effect were BZDs, antidepressants, and antipsychotics, whereas on the ARS, they were antidepressants followed by antipsychotics and, to a lesser extent, antihistamines. It is known that patients without cognitive impairment at the start of treatment with anticholinergic agents may develop cognitive impairment associated with long-term consumption Psychiatric complications farmafos HIV patients may require pharmacological treatment.
The neuroleptics and tricyclic antidepressants used to treat these complications have anticholinergic effects which may cause neuropsychological problems, such as memory deficit or confusion Benzodiazepines, which are used to treat afrmacos symptoms, are among other medications which may also cause concentration problems, framacos, or depressive symptoms The results showed that A German study 22 and a French prospective study 23 have referred to the risk of cognitive impairment and falls with the use of these agents in snticolinergicos adults.
Many patients, especially men, use higher doses than those recommended. Anticolindrgicos far as possible, the prescription of BZDs for older patients should be avoided Although no studies are available on the prescription of agents with anticholinergic risk in HIV patients 50 years or older, a systematic review and meta-analysis performed in in older patients 26 found that anticholinergic agents were associated with cognitive deterioration, falls, and death.
The most recent review was conducted in 27and concluded that a large number of studies, most of which included older adults, found an association between high values on the DBI and adverse changes in daily life activities. Given the evidence, clinicians should to take into account the risk of cognitive deterioration and falls that this group of drugs causes in an ageing population, such as HIV patients.
The prescription of these agents with hypnotic drugs, such as BZDs, could further increase cognitive impairment and falls. Polypharmacy is one of the problems associated with chronicity. The prescription of drugs with adverse effects, such as anticholinergic agents, could pose a risk in these types of patients whose neurological status may also be affected by the infection itself.
Looking for an Age Cut-Off. Aging with HIV infection: J Clin Exp Neuropsychol. Wendelken LA, Valcour V. Impact of HIV and aging on neuropsychological function.
Rev Psiquiatr Salud Ment. Anticholinergic Effects of Medication in Elderly Patients. Drugs with anticholinergic properties and cognitive performance in the elderly: Br J Clin Pharmacol. Long-term cognitive impact of anticholinergic medications in older adults.
Impact of anticholinergics on the aging brain: The anticholinergic risk scale and anticholinergic adverse effects in older persons. Anticholinergic medication use and dementia: Ther Adv Drug Saf. J Am Geriatr Soc. Cumulative anticholinergic exposure is associated with poor memory and executive function in older men. Neuropsychological response to antiretroviral therapy in HIV infection. In Grant I, Martin A, eds. Neuropsychology of HIV Infection.
Oxford University Press; Drugs that cause psychiatric symptoms. Benefits and risks of benzodiazepines and Z-drugs: Benzodiazepine use and risk of dementia: