OBJECTIVES: Anticholinergic burden in older adults with dementia is a significant concern as it can worsen dementia symptoms. However, little is about Cumulative Anticholinergic Burden (CAB) that considers both anticholinergic dose and duration in dementia. This study examined CAB based on Anticholinergic Cognitive Burden (ACB) scale and identified the factors associated with CAB in older adults with dementia.

METHODS: This was a cross-sectional study of older adults (≥65 years) with dementia (ICD-10-CM) using the 2018 Medical Expenditure Panel Survey (MEPS). Daily exposure for anticholinergics was divided by defined daily dose (DDD) by World Health Organization to obtain standardized daily dose (SDD). Each SDD was multiplied by ACB score to obtain drug-specific Standardized Daily Anticholinergic Exposure(SDACE). Values for SDACE were summed to obtain summated Standard Daily Anticholinergic Exposure (SumSDACE). The CAB was obtained by summing daily SumSDACE values over 12-month period. Multinomial logistic regression model was used to assess predisposing, enabling, and need factors associated with levels of CAB using the Andersen Behavioral Model framework.

RESULTS: According to the MEPS, there were 3.44 million older adults with dementia; 34.33%, 49.44%, and 16.23% had low, moderate, and high CAB, respectively. After controlling for factors, patients aged >85 years, 65-74 years were associated with lower odds of low CAB. Patients with urinary incontinence were associated with lower odds of high CAB, whereas patients with depression and memantine use were associated with higher odds of high CAB. Females, married, uninsured, patients in South, and those needing instrumental activities assistance were associated with higher odds of low CAB.

CONCLUSIONS: This study revealed that about half of dementia patients had moderate CAB. Predisposing, enabling, and need factors were associated with the CAB among older adults with dementia. The findings suggest the need to optimize CAB to minimize the worsening of cognition in this vulnerable population.