Relationship of the revised anticholinergic drug scale with cultured cell-based serum anticholinergic activity and cognitive measures in older adults with mild cognitive impairment or remitted depression

Ryan M Carnahan; Susmita Chandramouleeshwaran; Naba Ahsan; Roger Raymond; Jose N Nobrega; Wei Wang; Corinne E Fischer; Alastair J Flint; Nathan Herrmann; Sanjeev Kumar; Krista L Lanctôt; Linda Mah; Benoit H Mulsant; Bruce G Pollock; Tarek K Rajji

doi:10.1002/phar.70022

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Relationship of the revised anticholinergic drug scale with cultured cell-based serum anticholinergic activity and cognitive measures in older adults with mild cognitive impairment or remitted depression

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Relationship of the revised anticholinergic drug scale with cultured cell-based serum anticholinergic activity and cognitive measures in older adults with mild cognitive impairment or remitted depression

Ryan M Carnahan, Susmita Chandramouleeshwaran, Naba Ahsan, Roger Raymond, Jose N Nobrega, Wei Wang, Corinne E Fischer, Alastair J Flint, Nathan Herrmann, Sanjeev Kumar, …

Pharmacotherapy, Vol.45(6), pp.332-340

06/2025

DOI: 10.1002/phar.70022

PMCID: PMC12149784

PMID: 40326412

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Abstract

The Anticholinergic Drug Scale (ADS) is a commonly used measure of anticholinergic exposure. This study describes an expanded and revised version of the ADS (rADS) and its relationship with cultured cell-based serum anticholinergic activity (cSAA) and cognitive measures. Adults aged 60 years and older with mild cognitive impairment (MCI), remitted major depressive disorder (rMDD), or both, participate in the Prevention of Alzheimer's Dementia with Cognitive Remediation plus Transcranial Direct Current Stimulation (PACt-MD) study. Cross-sectional investigation of data from the PACt-MD study. The rADS includes ratings for 1047 distinct products, about twice as many as the originally published scale; previously published ratings were revised for 40 drugs. Total rADS scores were calculated as sums of ratings of all drugs taken by participants; cSAA was measured in the participants' sera; cognitive performance included measures of executive function, language, processing speed, verbal memory, visuospatial memory, working memory, and an overall composite score. The relationship between rADS total scores and cSAA was examined using a Spearman rank correlation coefficient. Relationships between rADS total scores and cognitive performance measures were explored in multivariable linear regression models. The sample included 310 participants (mean [standard deviation] age: 72 (6) years; 61.6% were women, and 81.6% had MCI [with or without rMDD]). Total rADS scores were positively correlated with cSAA (Spearman's correlation coefficient: 0.178, p = 0.0016). Total rADS scores were not significantly associated with cognitive performance. The revised scale is recommended as a replacement for the original ADS since it includes ratings for more drugs and was significantly, albeit weakly, associated with cSAA, similar to previous findings using the original ADS.

muscarinic antagonists

mild cognitive impairment

depression

cognition

polypharmacy

anticholinergic medications

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Details

Title: Subtitle: Relationship of the revised anticholinergic drug scale with cultured cell-based serum anticholinergic activity and cognitive measures in older adults with mild cognitive impairment or remitted depression
Creators: Ryan M Carnahan - Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa, USA
Susmita Chandramouleeshwaran - University of Ottawa
Naba Ahsan - Centre for Addiction and Mental Health
Roger Raymond - Centre for Addiction and Mental Health
Jose N Nobrega - Centre for Addiction and Mental Health
Wei Wang - Centre for Addiction and Mental Health
Corinne E Fischer - University of Toronto
Alastair J Flint - University Health Network
Nathan Herrmann - Sunnybrook Health Science Centre
Sanjeev Kumar - University of Toronto
Krista L Lanctôt - Sunnybrook Health Science Centre
Linda Mah - Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, Ontario, Canada
Benoit H Mulsant - University of Toronto
Bruce G Pollock - University of Toronto
Tarek K Rajji - University of Toronto
Resource Type: Journal article
Publication Details: Pharmacotherapy, Vol.45(6), pp.332-340
DOI: 10.1002/phar.70022
PMID: 40326412
PMCID: PMC12149784
NLM abbreviation: Pharmacotherapy
ISSN: 0277-0008
eISSN: 1875-9114
Publisher: Wiley
Grant note: Health Canada The Chagnon Family Canada Brain Research Fund of Brain Canada Centre for Addiction and Mental Health Discovery Fund
Language: English
Electronic publication date: 05/06/2025
Date published: 06/2025
Academic Unit: Epidemiology; Nursing; Injury Prevention Research Center
Record Identifier: 9984821347902771

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