Evidence map›Paper›PMID 31046175›Full record

ArticleBritish journal of clinical pharmacology2019

Anticholinergic medicines use among older adults before and after initiating dementia medicines.

Sujita W Narayan, Sallie-Anne Pearson, Melisa Litchfield, David G Le Couteur, Nicholas Buckley, Andrew J McLachlan, Helga Zoega

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of clinical pharmacology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 2 pooled it
1.3field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 14 citations in OpenAlex.

  1. Pooled it
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  5. Real-World Complexity of Prescribing Cascades.Basic & clinical pharmacology & toxicology · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 3 countries.

Sujita W NarayanCentre for Big Data Research in Health, University of New South Wales, Sydney, Australia.ORCID 0000-0001-8706-2113
Sallie-Anne PearsonCentre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
Melisa LitchfieldCentre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
David G Le CouteurCentre for Education and Research in Ageing, Concord Hospital, Sydney, Australia.
Nicholas BuckleySydney Medical School, The University of Sydney, Sydney, Australia.
Andrew J McLachlanCentre for Education and Research in Ageing, Concord Hospital, Sydney, Australia.
Helga ZoegaCentre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
The University of Sydney · AUUNSW Sydney · AUUniversity of Iceland · IS

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsWe investigated anticholinergic medicines use among older adults initiating dementia medicines.

methodsWe used Pharmaceutical Benefits Scheme dispensing claims to identify patients who initiated donepezil, rivastigmine, galantamine or memantine between 1 January 2013 and 30 June 2017 (after a period of ≥180 days with no dispensing of these medicines) and remained on therapy for ≥180 days (n = 4393), and dispensed anticholinergic medicines in the 180 days before and after initiating dementia medicines. We further examined anticholinergic medicines prescribed by a prescriber other than the one initiating dementia medicines.

resultsOne-third of the study cohort (1439/4393) was exposed to anticholinergic medicines up to 180 days before or after initiating dementia medicines. Among patients exposed to anticholinergic medicines, 46% (659/1439) had the same medicine dispensed before and after initiating dementia medicines. The proportion of patients dispensed anticholinergic medicines increased by 2.5% (95% confidence interval [CI]: 1.3-3.7) after initiating dementia medicines. Antipsychotics use increased by 10.1% (95% CI: 7.6-12.7) after initiating dementia medicines; driven by increased risperidone use (7.3%, 95% CI: 5.3-9.3). Nearly half of patients dispensed anticholinergic medicines in the 180 days after (537/1133), were prescribed anticholinergic medicines by a prescriber other than the one initiating dementia medicines.

conclusionUse of anticholinergic medicines is common among patients initiating dementia medicines and this occurs against a backdrop of widespread campaigns to reduce irrational medicine combinations in this vulnerable population. Decisions about deprescribing medicines with questionable benefit among patients with dementia may be complicated by conflicting recommendations in prescribing guidelines.

Indexed as

AgedAged, 80 and overAntipsychotic AgentsAustraliaCholinergic AntagonistsCholinesterase InhibitorsDementiaDeprescriptionsDonepezilDrug PrescriptionsFemaleHumansMaleMemantineMiddle AgedRetrospective StudiesAntipsychotic AgentsCholinergic AntagonistsCholinesterase InhibitorsDonepezilMemantineRisperidoneRivastigmineanticholinergicsAustraliacholinesterase inhibitorsdementiaolder adultspharmacoepidemiologypotentially inappropriate medicines

Identifiers

PMID31046175
PMCPMC6710547
OpenAlexW2943692303

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.