The adverse effects of long-term exposure to anticholinergics among people with intellectual disabilities: a scoping review

Lamya Al Shuhaimi; Martin Henman; Philip McCallion; Mary McCarron; Maire O'Dwyer

doi:10.12688/hrbopenres.13599.1

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Systematic Review

The adverse effects of long-term exposure to anticholinergics among people with intellectual disabilities: a scoping review

[version 1; peer review: 2 approved]

Lamya Al Shuhaimi ¹, Martin Henman¹, Philip McCallion², Mary McCarron³, Maire O'Dwyer¹

Lamya Al Shuhaimi ¹, Martin Henman¹, [...] Philip McCallion², Mary McCarron³, Maire O'Dwyer¹

PUBLISHED 30 Sep 2022

Author details Author details

¹ School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, D02 PN40, Ireland
² School of Social Work, Temple University, Philadelphia, PA, 19122, USA
³ Trinity Centre for Ageing and Intellectual Disability, Trinity College Dublin, Dublin, D01 W596, Ireland

Lamya Al Shuhaimi
Roles: Conceptualization, Data Curation, Methodology, Resources, Validation, Writing – Original Draft Preparation

Martin Henman
Roles: Conceptualization, Methodology, Project Administration, Resources, Supervision, Writing – Review & Editing

Philip McCallion
Roles: Resources, Supervision, Writing – Review & Editing

Mary McCarron
Roles: Resources, Supervision, Writing – Review & Editing

Maire O'Dwyer
Roles: Conceptualization, Methodology, Project Administration, Resources, Supervision, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Dementia Trials Ireland (DTI) and Dementia Research Network Ireland (DRNI) gateway.

This article is included in the TILDA gateway.

Abstract

Background: Older adults with intellectual disability are exposed to a higher anticholinergic burden compared to general older adults. This is due to a higher rate of both mental and neurological disorders among people with intellectual disability. The use of medications with a high anticholinergic burden is associated with adverse effects including daytime dozing, constipation and higher dependence level in the Barthel index for measuring activities of daily living. This scoping review aims to map and examine the existing research on physical and cognitive adverse effects associated with the long-term impact of anticholinergics among people with intellectual disabilities.
Methods: The search was conducted in: PubMed, Cochrane library, EMBASE, Medline, Science Direct, CINAHL Complete and PsycINFO. Preliminary studies, grey literature, and conference papers were searched in related electronic databases. The search terms included terms related to ‘anticholinergic’, ‘long-term exposure’, ‘intellectual disability’ and ‘adverse drug reaction’ with Boolean operator ‘and’. Studies with at least three months’ exposure to anticholinergics were included. The search was restricted to research papers on people with intellectual disability aged 40 or over and publication in the English language only. Initially, it was conducted in May and June 2021 and covered the publication period between 1970 and 2021. It was re-run in October 2021.
Results: The conducted search provided 509 records of publications and grey literature. Duplicates were removed using EndNote 20 and resulted in 432 remaining records. Then, 426 further records were excluded because they were deemed irrelevant, or non-longitudinal studies or conducted on different populations. Only six full articles were retrieved to assess their eligibility and all were excluded due to different study populations. This resulted in no studies meeting the stated inclusion criteria.
Conclusions: Further research is urgently required to examine the long-term adverse effects associated with higher anticholinergic scores among older people with intellectual disability.

Keywords

anticholinergic burden, intellectual disability, long-term adverse effects, older adults

Corresponding author: Lamya Al Shuhaimi

Competing interests: No competing interests were disclosed.

Grant information: Health Research Board Ireland [IDS-TILDA-2018-1]. The lead author (LAA) received funding from Provost PhD Awards Graduate Studies from the Trinity College Dublin. The views expressed are those of the authors and are not necessarily those of the Department of Health, the Health Research Board or Trinity College Dublin. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2022 Al Shuhaimi L et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Al Shuhaimi L, Henman M, McCallion P et al. The adverse effects of long-term exposure to anticholinergics among people with intellectual disabilities: a scoping review [version 1; peer review: 2 approved]. HRB Open Res 2022, 5:63 (https://doi.org/10.12688/hrbopenres.13599.1) First published: 30 Sep 2022, 5:63 (https://doi.org/10.12688/hrbopenres.13599.1) Latest published: 30 Sep 2022, 5:63 (https://doi.org/10.12688/hrbopenres.13599.1)

Introduction

Medicines with anticholinergic (AC) activity are widely used among older adults due to their potential clinical benefits in managing a wide range of medical conditions¹. These medicines are usually used for peptic ulcer disorders, irritable bowel syndrome, urinary disorders, Parkinson’s disease, neurological diseases, psychiatric conditions and as anaesthetic agents.

There are well-recognized adverse effects associated with the use of AC which include: dry, pale and cool skin, dry mouth with difficulty beginning to speak, urinary diseases, blurred vision, unsteady movement and falls, anxiety, tachycardia, cardiac arrhythmias, etc². In addition, there are several central anticholinergic adverse effects associated with anticholinergic drugs that can cross the blood brain barrier such as memory impairment, agitation, hallucination, delirium, confusion and disorientation.

In certain medical conditions that are usually associated with aging, the benefits of AC use are greater than their risks; therefore, it is inevitable and appropriate that they be used¹. These conditions include: psychiatric disorders (such as bipolar disorder, obsessive-compulsive disorders, severe insomnia, severe anxiety diseases, drug-induced acute dystonia, secondary Parkinsonism) and non-psychiatric conditions (such as gastroesophageal reflux disease, irritable bowel syndrome, urinary incontinence, neuropathic pain, cardiovascular disorders, muscle spasms and low back pain).

People with intellectual disabilities experience a higher incidence of morbidities, by 2.5 times, compared to the general population³. They have a higher incidence of some diseases such as dementia, dental disorders, psychiatric diseases, osteoporosis and epilepsy. Furthermore, prevalence of polypharmacy is higher in people with an intellectual disability, and they are described as one of the most medicated groups of the population. A study conducted in Ireland has identified that older adults with intellectual disability are exposed to excessive polypharmacy (10 medications or more) at rates 10 times higher than the general population³. Moreover, they are exposed to a high anticholinergic burden^4,5 due to the high prevalence of mental disorders and neurological disorders^6,7. Furthermore, a Scottish cohort study reported that anticholinergic burden was relatively high among all age groups of people with intellectual disability including adults and older adults (17–94 years old)⁵. Notably, the greatest anticholinergic burden was observed in people aged ≥ 55 years and in females.

High anticholinergic burden was associated with a higher likelihood of reporting constipation, daytime dozing and use of multiple laxatives in the elderly with intellectual disabilities⁴. Another study reported that a higher Drug Burden Index (DBI) was associated with higher dependence scores in the Barthel index for measuring activities of daily living in older adults with intellectual disabilities⁸.

The long-term impact of anticholinergics has been examined by some studies among the general geriatric population. These studies have reported an association between long-term cumulative high anticholinergic burden and poorer physical function^9–11, cognitive impairment^9–13, and a higher incident of dementia¹⁴. Another study found that high anticholinergic burden can predict mortality among elderly patients discharged from hospital with a high Geriatric Depression Scale (GDS) score¹⁵.

According to our preliminary research, there has been no or limited research exploring the long-term impact of anticholinergics among older adults with an intellectual disability. Therefore, this scoping review aims to map and examine the existing research literature on physical and cognitive adverse effects associated with the long-term impact of anticholinergics among people with intellectual disabilities.

Methods

This scoping review followed the framework proposed by Arksey and O’Malley¹⁶ and its developed version by Levac¹⁷. Moreover, the Joanna Briggs Institute reviewer’s manual¹⁸ and the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR)¹⁹ were also followed. Accordingly, there were six stages in conducting the review:

1. Identification of the research question
2. Identification of relevant studies
3. Selection of studies
4. Data charting
5. Collating, summarising and reporting the results
6. Consultation

A protocol²⁰ of this scoping review was published previously and provides more details of the methods used. (https://doi.org/10.12688/hrbopenres.13266.1)

Stage 1: Identification of the research question

As per our best knowledge, there was no research exploring the adverse effects associated with the long-term exposure to anticholinergics among older adults with intellectual disabilities. This scoping review was therefore conducted to answer the following question:

What are the adverse effects on cognitive and physical outcomes of long-term exposure to medications with anticholinergic activity among older adults with intellectual disabilities?

As a long-term goal, this review aimed to produce findings likely to enhance prescribing patterns among this vulnerable group of people.

Stage 2: Identification of relevant studies

The search was conducted in seven electronic databases: PubMed, Cochrane library, EMBASE, Medline, Science Direct, CINAHL Complete and PsycINFO. Additionally, preliminary studies, grey literature, and conference papers were searched in Google Scholar, The Turning Research Into Practice (TRIP) database, ClinicalTrials.gov, PROSPERO, EU Clinical Trial Register, Open Grey, the WHO International Clinical Trials Registry Platform search portal (ICTRP), International Standard Randomised Controlled Trial Number (ISRCTN) registry, Chinese Clinical Trial Registry (ChiCTR), Australian New Zealand Clinical Trials Registry (ANZCTR), Pan African Clinical Trials Registry (PACTR) and Clinical Trials Registry—India (CTRI).

The search terms used to conduct the electronic search consisted of four terms/phrases and these were ‘anticholinergic’, ‘long-term exposure’, ‘intellectual disability’ and ‘adverse drug reaction’. The keywords and Medical Subject Headings (MeSH) terms for each phrase was searched with Boolean operator ‘AND’. Table 1 provides the keywords used to conduct the search.

Table 1. Search keywords: the table illustrates the terms used for conduction of the search using the electronic databases.

Anticholinergic	Long-term Exposure	Intellectual Disability	Adverse Drug Reaction
‘anticholinergic burden’ OR ‘anticholinergic exposure’ OR ‘anticholinergic’ OR ‘cholinergic antagonist’ OR ‘antimuscarinic drugs’ OR ‘ muscarinic antagonist’ OR ‘ anticholinergic’ OR ‘ anticholinergic agent’ OR ‘ antimuscarinic’ OR ‘ antimuscarinic agent’ OR ‘cholinergic blocking agent’ OR ‘acetylcholine antagonist’ OR ‘cholinergic receptor antagonist’ OR ‘cholinergic antagonists’ OR ‘cholinolytics’	‘chronic use’ OR ‘long-term use’ OR ‘ ≥ 3 months’	‘cognitive impairment’ OR ‘intellectual disabilities’ OR ‘learning disabilities’ OR ‘developmental disabilities’ OR ‘mentally disabled persons’ OR ‘handicap’ OR ‘Down Syndrome’ OR ‘mental retardation’ OR ‘intellectual development disorders’ OR ‘psychosocial mental retardation’ OR ‘mental deficiency’ OR ‘mentally disabled’ OR ‘mentally handicapped’ OR ‘persons with intellectual disability’ OR ‘mentally retarded’	‘adverse effect’ OR ‘drug toxicity’ OR ‘adverse outcomes’ OR ‘side effects’ OR ‘drug related side effects’ and ‘adverse reactions’ OR ‘side effects of drugs’ OR ‘drug side effects’ OR ‘adverse drug reactions’ OR ‘adverse drug event’ OR ‘anticholinergic toxicity’ OR ‘anticholinergic effect’ OR ‘anticholinergic syndrome’ OR ‘peripheral anticholinergic syndrome’ OR ‘central anticholinergic syndrome’ OR ‘anticholinergic toxicity’ OR ‘anticholinergic effect’ OR ‘cognitive function’ OR ‘cognitive disorder’ OR ‘cognitive impairment’ OR ‘ dementia’ OR ‘delirium’ OR ‘physical function’ OR ‘ physical activity’ OR ‘frailty’ OR ‘falls’ OR ‘accidental falls’ OR ‘hip fracture’ OR ‘mortality’ OR ‘death’ OR ‘constipation’ OR ‘urinary incontinence’

There is no identified age range to describe older adults with intellectual disability. However, most of the published papers considered that older adults with intellectual disability are those aged ≥ 40 years old^4,7,8,21. Therefore, the search was restricted to research papers on people with intellectual disability aged 40 or over and publication in English language only. It was conducted in May and June 2021 (2021-05-29, 2021-06-10, 2021-06-14) and covered the publication period between 1970 and 2021. The search was re-run again in October 2021.

Stage 3: Selection of studies

Studies were included according to the inclusion and exclusion criteria. The titles and abstracts were screened by team member ‘LAA’ to assess their eligibility according to the stated inclusion criteria. A second reviewer (MO’D) screened the retrieved articles to independently confirm their eligibility. A Microsoft Word (Version 16.63.1) document was prepared that included the details of search records such as keywords, MeSH terms, search limitations, results and number of included articles for each electronic database used, as summarized above.

Figure 1. PRISMA flow chart illustrating the process of study selection.

Inclusion criteria

Study design

All designs and types of study were included.

Study population

Only studies on people with intellectual disability were included. Intellectual disability usually occurs prior to age 18 and it is defined as “a disability characterized by significant limitations in both intellectual functioning and adaptive behaviour, which covers many everyday social and practical skills.” [https://www.aaidd.org/]. Various types and stages of intellectual disability are included in this scoping review.

Furthermore, the review only included studies on older adults aged 40 or more with intellectual disability. Children and adults with intellectual disability who were aged less than 40 years were excluded from the review.

Intervention

‘Long-term use’ or ‘Chronic use’ of medicines has been defined as being on a medicine for at least three months or longer [https://www.medicinenet.com/]. Therefore, the review included all studies that examined the adverse outcomes associated with the use of anticholinergics for a period of three months or longer. There was no restriction on tools used to identify anticholinergic burden.

Context

The review included research papers in all different care settings where people with intellectual disability can live, including institutions, nursing homes, community group homes, with families or independently.

Outcomes

This scoping review examined both cognitive and physical outcomes associated with the long-term exposure to anticholinergics in older adults with intellectual disability. The physical and cognitive outcomes include all of the reported and measured central and peripheral adverse effects associated the long-term use of these medications. There are no restrictions of tools used to report or measure the adverse outcomes.

figure 1 illustrates the process of study selection according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Stage 6: Consultation

Expert members of The Royal College of Psychiatrists of Ireland (Intellectual disability subgroup), Providers in Ireland: Daughters of Charity Service, Down Syndrome Ireland, National Intellectual Disability Memory Service, Tallaght Hospital and the International Association for the Scientific Study of Intellectual and Developmental Disabilities (IASSIDD) were consulted verbally or by email on the scoping review research question and its findings.

Differences between protocol and review

Stage 2: Identification of relevant studies

Open Grey was also searched for unpublished articles. It wasn’t included in the previously published review protocol.

Stages 4 and 5: Data charting, collating, summarising and reporting the results

A data extraction form was developed to chart information from the included studies. The form was designed to include key information from each included article such as title, aim, population, results, conclusion and implications. However, none of the studies fitted the stated inclusion criteria. Therefore, there was no data to be charted, collated, summarized and reported.

Results

Description of studies

The initial search conducted in May and June 2021 was re-run on 2021-10-05 and 2021-10-08 and provided 509 records of both publications and grey literature. Duplicates were removed by using EndNote 20 (RRID:SCR_014001) and resulted in 432 remaining records. Then, the records were screened for relevance based on the titles and abstracts by two members of the search team. After that, 426 further records were excluded because they were deemed irrelevant, or non-longitudinal studies or conducted on different populations. Only six full articles were retrieved to assess their eligibility to be included in the stated inclusion criteria. Two members (MO’D, LAA) of the research team assessed the remaining six records for their relevance and all were excluded due to different studied populations. This resulted in no studies meeting the stated inclusion criteria.

Consultation findings

Representative members from The Royal College of Psychiatrists of Ireland (Intellectual disability subgroup), Down Syndrome Ireland and the International Association for the Scientific Study of Intellectual and Developmental Disabilities (IASSIDD) replied to our consultation request. The representatives highlighted the reasons such prescribing occurs, the particular risk for persons with Down syndrome, the important role played by the longitudinal study findings and the acceptance that research in this area must become a scientific priority. No concerns were noted about the review findings.

Discussion

As far as we are aware, this is the first scoping review to examine the adverse effects of long-term exposure to anticholinergics among older adults with intellectual disability. This scoping review aimed to map and examine the available research. However, no studies were identified that met the inclusion criteria of the review and an empty review (a review with no studies eligible for inclusion based on the inclusion criteria²².) has been reported. This fits a pattern of 15 empty reviews out of 81 reported systematic reviews conducted on people with developmental, psychosocial and learning problems²³.

Empty reviews help to identify important gaps in knowledge and to stimulate researchers towards topic areas that need to be studied²⁴. According to studies that were screened in this scoping review, there is some limited identification of the prevalence of anticholinergic burden and the associated short-term adverse effects among people with intellectual disability. In addition, the long-term adverse impact of anticholinergics has been examined among the general population^9–15, patients with cognitive impairments, dementia and Alzheimer’s disease^25–29. That there are few or no studies conducted among people with intellectual disability in an area where there are published studies for the general population suggests people with intellectual disabilities still remain mostly excluded from participating in clinical research⁶. It is of further concern that there is therefore a restricted evidence base for safe use of these medicines among this vulnerable group of the population.

Conclusions

In conclusion, further research is urgently required to examine the long-term adverse effects associated with higher anticholinergic scores among older people with intellectual disability.

Data availability

Underlying data

Open Science Framework (OSF): Underlying data for ‘The adverse effects of long-term exposure to anticholinergics among people with intellectual disabilities: a scoping review’. https://doi.org/10.17605/OSF.IO/CVZX3¹⁹.

Reporting guidelines

Open Science Framework (OSF): PRISMA-ScR checklist for ‘The adverse effects of long-term exposure to anticholinergics among people with intellectual disabilities: a scoping review’. https://doi.org/10.17605/OSF.IO/CVZX3¹⁹.

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

Faculty Opinions recommended

References

1. López-Álvarez J, Sevilla-Llewellyn-Jones J, Agüera-Ortiz L: Anticholinergic Drugs in Geriatric Psychopharmacology. Front Neurosci. 2019; 13: 1309. PubMed Abstract | Publisher Full Text | Free Full Text
2. Mintzer J, Burns A: Anticholinergic side-effects of drugs in elderly people. J R Soc Med. 2000; 93(9): 457–462. PubMed Abstract | Publisher Full Text | Free Full Text
3. O'Dwyer M, Peklar J, McCallion P, et al.: Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ Open. 2016; 6(4): e010505. PubMed Abstract | Publisher Full Text | Free Full Text
4. O'Dwyer M, Maidment I, Bennett K, et al.: Association of anticholinergic burden with adverse effects in older people with intellectual disabilities: an observational cross-sectional study. Br J Psychiatry. 2016; 209(6): 504–510. PubMed Abstract | Publisher Full Text
5. Ward LM, Stanley B, Greenlaw N, et al.: Risk of anticholinergic burden in adults with intellectual disabilities: a Scottish retrospective cohort study of n = 17 220. J Intellect Disabil Res. 2021; 65(9): 813–830. PubMed Abstract | Publisher Full Text
6. O’Dwyer M, McCallion P, McCarron M, et al.: Measuring drug burden in older adults with intellectual disabilities: Critical issues for consideration in finding the optimal measure to improve safety of medicines use. Expert Opin Drug Saf. 2020; 19(6): 649–652. PubMed Abstract | Publisher Full Text
7. De Vreese L, Mantesso U, De Bastiani E, et al.: Anticholinergic burden in adult and elderly people with intellectual disabilities: Results from an Italian multicenter cross-sectional study. PLoS One. 2018; 13(10): e0205897. PubMed Abstract | Publisher Full Text | Free Full Text
8. O'Connell J, Burke É, Mulryan N, et al.: Drug burden index to define the burden of medicines in older adults with intellectual disabilities: An observational cross-sectional study. Br J Clin Pharmacol. 2018; 84(3): 553–567. PubMed Abstract | Publisher Full Text | Free Full Text
9. Wouters H, Hilmer SN, Gnjidic D, et al.: Long-Term Exposure to Anticholinergic and Sedative Medications and Cognitive and Physical Function in Later Life. J Gerontol A Biol Sci Med Sci. 2019; 75(2): 357–365. PubMed Abstract | Publisher Full Text
10. Han L, Agostini JV, Allore HG: Cumulative Anticholinergic Exposure Is Associated with Poor Memory and Executive Function in Older Men. J Am Geriatr Soc. 2008; 56(12): 2203–2210. PubMed Abstract | Publisher Full Text | Free Full Text
11. Brombo G, Bianchi L, Maietti E, et al.: Association of Anticholinergic Drug Burden with Cognitive and Functional Decline Over Time in Older Inpatients: Results from the CRIME Project. Drugs Aging. 2018; 35(10): 917–924. PubMed Abstract | Publisher Full Text
12. Cai X, Campbell N, Khan B, et al.: Long-term anticholinergic use and the aging brain. Alzheimers Dement. 2012; 9(4): 377–385. PubMed Abstract | Publisher Full Text | Free Full Text
13. Jamsen KM, Gnjidic D, Hilmer SN, et al.: Drug Burden Index and change in cognition over time in community-dwelling older men: the CHAMP study. Ann Med. 2016; 49(2): 157–164. PubMed Abstract | Publisher Full Text
14. Gray SL, Anderson ML, Dublin S, et al.: Cumulative Use of Strong Anticholinergics and Incident Dementia. JAMA Intern Med. 2015; 175(3): 401–7. PubMed Abstract | Publisher Full Text | Free Full Text
15. Corsonello A, Cozza A, D'Alia S, et al.: The excess mortality risk associated with anticholinergic burden among older patients discharged from acute care hospital with depressive symptoms. Eur J Intern Med. 2019; 61: 69–74. PubMed Abstract | Publisher Full Text
16. Arksey H, O'Malley L: Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005; 8(1): 19–32. Publisher Full Text
17. Levac D, Colquhoun H, O'Brien KK: Scoping studies: advancing the methodology. Implement Sci. 2010; 5(1): 69. PubMed Abstract | Publisher Full Text | Free Full Text
18. The Joanna Briggs Institute: The Joanna Briggs Institute Reviewers’ manual 2015 - methodology for JBI scoping reviews. Adelaide, South Australia, 2015. Reference Source
19. Shuahimi L: The adverse effects of long-term exposure to anticholinergics among people with intellectual disabilities: a scoping review. Open Science Framework. [Dataset]. 2022. http://www.doi.org/10.17605/OSF.IO/CVZX3
20. Al Shuhaimi L, Henman M, McCallion P, et al.: The impact of long-term exposure to anticholinergics among people with intellectual disabilities: a scoping review protocol [version 1; peer review: 1 approved with reservations]. HRB Open Res. 2021; 4: 62. Publisher Full Text
21. O’Connell J, Henman MC, Burke É, et al.: Association of Drug Burden Index with grip strength, timed up and go and Barthel index activities of daily living in older adults with intellectual disabilities: an observational cross-sectional study. BMC Geriatr. 2019; 19(1): 173. PubMed Abstract | Publisher Full Text | Free Full Text
22. Lang A, Edwards N, Fleiszer A: Empty systematic reviews: hidden perils and lessons learned. J Clin Epidemiol. 2007; 60(6): 595–597. PubMed Abstract | Publisher Full Text
23. Yaffe J, Montgomery P, Hopewell S, et al.: Empty Reviews: A Description and Consideration of Cochrane Systematic Reviews with No Included Studies. PLoS One. 2012; 7(5): e36626. PubMed Abstract | Publisher Full Text | Free Full Text
24. Gray R: Empty systematic reviews: Identifying gaps in knowledge or a waste of time and effort? Nurse Author Ed. 2021; 31(2): 42–44. Publisher Full Text
25. Fox C, Livingston G, Maidment ID, et al.: The impact of anticholinergic burden in Alzheimer's Dementia-the Laser-AD study. Age Ageing. 2011; 40(6): 730–735. PubMed Abstract | Publisher Full Text
26. Ah YM, Suh Y, Jun K, et al.: Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population‐based study. Basic Clin Pharmacol Toxicol. 2019; 124(6): 741–748. PubMed Abstract | Publisher Full Text
27. Naharci MI, Cintosun U, Ozturk A, et al.: Effect of anticholinergic burden on the development of dementia in older adults with subjective cognitive decline. Psychiatry and Clinical Psychopharmacology. 2017; 27(3): 263–270. Publisher Full Text
28. Dyer AH, Murphy C, Segurado R, et al.: Is Ongoing Anticholinergic Burden Associated With Greater Cognitive Decline and Dementia Severity in Mild to Moderate Alzheimer's Disease? J Gerontol A Biol Sci Med Sci. 2020; 75(5): 987–994. PubMed Abstract | Publisher Full Text
29. Green AR, Reifler LM, Bayliss EA, et al.: Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study. Drugs Aging. 2019; 36(3): 289–297. PubMed Abstract | Publisher Full Text | Free Full Text

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Author details Author details

¹ School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, D02 PN40, Ireland
² School of Social Work, Temple University, Philadelphia, PA, 19122, USA
³ Trinity Centre for Ageing and Intellectual Disability, Trinity College Dublin, Dublin, D01 W596, Ireland

Lamya Al Shuhaimi
Roles: Conceptualization, Data Curation, Methodology, Resources, Validation, Writing – Original Draft Preparation

Martin Henman
Roles: Conceptualization, Methodology, Project Administration, Resources, Supervision, Writing – Review & Editing

Philip McCallion
Roles: Resources, Supervision, Writing – Review & Editing

Mary McCarron
Roles: Resources, Supervision, Writing – Review & Editing

Maire O'Dwyer
Roles: Conceptualization, Methodology, Project Administration, Resources, Supervision, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

Health Research Board Ireland [IDS-TILDA-2018-1]. The lead author (LAA) received funding from Provost PhD Awards Graduate Studies from the Trinity College Dublin. The views expressed are those of the authors and are not necessarily those of the Department of Health, the Health Research Board or Trinity College Dublin. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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https://doi.org/10.12688/hrbopenres.13599.1

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© 2022 Al Shuhaimi L et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Al Shuhaimi L, Henman M, McCallion P et al. The adverse effects of long-term exposure to anticholinergics among people with intellectual disabilities: a scoping review [version 1; peer review: 2 approved]. HRB Open Res 2022, 5:63 (https://doi.org/10.12688/hrbopenres.13599.1)

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Reviewer Report 28 Jun 2023

David Harley, UQ Centre for Clinical Research, The University of Queensland, Herston, Qld, Australia

Approved

https://doi.org/10.21956/hrbopenres.14858.r34306

This is a well written review dealing with an important issue in developmental disability medicine. As the authors point out, while it is an empty review this, again, highlights the importance of research on prescribing, particularly polypharmacy and drugs with ... Continue reading

This is a well written review dealing with an important issue in developmental disability medicine. As the authors point out, while it is an empty review this, again, highlights the importance of research on prescribing, particularly polypharmacy and drugs with significant adverse effects, to people with intellectual and developmental disability.

I have no substantive criticisms of the review. Below I note some minor areas for improvement of the manuscript.

In the introduction, change "Parkinson’s disease, neurological diseases" to "neurological diseases including Parkinson's".
In the sentence stating that people with intellectual disability experience "a higher incidence of morbidities, by 2.5 times, compared to the general population", I suspect "incidence" should be "prevalence". Please check and correct if appropriate.
In the sentence "Another study found that high anticholinergic burden can predict mortality among elderly patients discharged from hospital with a high Geriatric Depression Scale (GDS) score "predict" should be replaced with a word or phrase implying association rather than causation.
I don't think team member initials need to be in inverted commas (only occurs once for member LAA).

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Yes
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Adult developmental disability medicine, focussing particularly on psychotropic prescribing.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report 09 Jan 2023

Carrie Stewart, Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK

Approved

https://doi.org/10.21956/hrbopenres.14858.r33305

This is well written and thorough systematic review in a novel research area and I thank the authors for their efforts in publishing this empty review. The search strategy appears thorough, has included grey literature and I am satisfied that ... Continue reading

This is well written and thorough systematic review in a novel research area and I thank the authors for their efforts in publishing this empty review. The search strategy appears thorough, has included grey literature and I am satisfied that the conclusions (empty review) are justifiable and reported within correct reporting guidelines.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Not applicable
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Deprescribing; ageing health

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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VERSION 1 PUBLISHED 30 Sep 2022

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	Invited Reviewers
	1	2
Version 1 30 Sep 22	read	read

Carrie Stewart, University of Aberdeen, Aberdeen, UK
David Harley, The University of Queensland, Herston, Australia

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Reviewer Report

19 Views

28 Jun 2023 | for Version 1

David Harley, UQ Centre for Clinical Research, The University of Queensland, Herston, Qld, Australia

19 Views Cite this report Responses(0)

Approved

This is a well written review dealing with an important issue in developmental disability medicine. As the authors point out, while it is an empty review this, again, highlights the importance of research on prescribing, particularly polypharmacy and drugs with significant adverse effects, to people with intellectual and developmental disability.

I have no substantive criticisms of the review. Below I note some minor areas for improvement of the manuscript.

In the introduction, change "Parkinson’s disease, neurological diseases" to "neurological diseases including Parkinson's".
In the sentence stating that people with intellectual disability experience "a higher incidence of morbidities, by 2.5 times, compared to the general population", I suspect "incidence" should be "prevalence". Please check and correct if appropriate.
In the sentence "Another study found that high anticholinergic burden can predict mortality among elderly patients discharged from hospital with a high Geriatric Depression Scale (GDS) score "predict" should be replaced with a word or phrase implying association rather than causation.
I don't think team member initials need to be in inverted commas (only occurs once for member LAA).

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Yes
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Adult developmental disability medicine, focussing particularly on psychotropic prescribing.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

26 Views

09 Jan 2023 | for Version 1

Carrie Stewart, Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK

26 Views Cite this report Responses(0)

Approved

This is well written and thorough systematic review in a novel research area and I thank the authors for their efforts in publishing this empty review. The search strategy appears thorough, has included grey literature and I am satisfied that the conclusions (empty review) are justifiable and reported within correct reporting guidelines.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Not applicable
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Deprescribing; ageing health

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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[1] 1. López-Álvarez J, Sevilla-Llewellyn-Jones J, Agüera-Ortiz L: Anticholinergic Drugs in Geriatric Psychopharmacology. Front Neurosci. 2019; 13: 1309. PubMed Abstract | Publisher Full Text | Free Full Text

[2] 2. Mintzer J, Burns A: Anticholinergic side-effects of drugs in elderly people. J R Soc Med. 2000; 93(9): 457–462. PubMed Abstract | Publisher Full Text | Free Full Text

[3] 3. O'Dwyer M, Peklar J, McCallion P, et al.: Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ Open. 2016; 6(4): e010505. PubMed Abstract | Publisher Full Text | Free Full Text

[4] 4. O'Dwyer M, Maidment I, Bennett K, et al.: Association of anticholinergic burden with adverse effects in older people with intellectual disabilities: an observational cross-sectional study. Br J Psychiatry. 2016; 209(6): 504–510. PubMed Abstract | Publisher Full Text

[5] 5. Ward LM, Stanley B, Greenlaw N, et al.: Risk of anticholinergic burden in adults with intellectual disabilities: a Scottish retrospective cohort study of n = 17 220. J Intellect Disabil Res. 2021; 65(9): 813–830. PubMed Abstract | Publisher Full Text

[6] 6. O’Dwyer M, McCallion P, McCarron M, et al.: Measuring drug burden in older adults with intellectual disabilities: Critical issues for consideration in finding the optimal measure to improve safety of medicines use. Expert Opin Drug Saf. 2020; 19(6): 649–652. PubMed Abstract | Publisher Full Text

[7] 7. De Vreese L, Mantesso U, De Bastiani E, et al.: Anticholinergic burden in adult and elderly people with intellectual disabilities: Results from an Italian multicenter cross-sectional study. PLoS One. 2018; 13(10): e0205897. PubMed Abstract | Publisher Full Text | Free Full Text

[8] 8. O'Connell J, Burke É, Mulryan N, et al.: Drug burden index to define the burden of medicines in older adults with intellectual disabilities: An observational cross-sectional study. Br J Clin Pharmacol. 2018; 84(3): 553–567. PubMed Abstract | Publisher Full Text | Free Full Text

[9] 9. Wouters H, Hilmer SN, Gnjidic D, et al.: Long-Term Exposure to Anticholinergic and Sedative Medications and Cognitive and Physical Function in Later Life. J Gerontol A Biol Sci Med Sci. 2019; 75(2): 357–365. PubMed Abstract | Publisher Full Text

[10] 10. Han L, Agostini JV, Allore HG: Cumulative Anticholinergic Exposure Is Associated with Poor Memory and Executive Function in Older Men. J Am Geriatr Soc. 2008; 56(12): 2203–2210. PubMed Abstract | Publisher Full Text | Free Full Text

[11] 11. Brombo G, Bianchi L, Maietti E, et al.: Association of Anticholinergic Drug Burden with Cognitive and Functional Decline Over Time in Older Inpatients: Results from the CRIME Project. Drugs Aging. 2018; 35(10): 917–924. PubMed Abstract | Publisher Full Text

[12] 12. Cai X, Campbell N, Khan B, et al.: Long-term anticholinergic use and the aging brain. Alzheimers Dement. 2012; 9(4): 377–385. PubMed Abstract | Publisher Full Text | Free Full Text

[13] 13. Jamsen KM, Gnjidic D, Hilmer SN, et al.: Drug Burden Index and change in cognition over time in community-dwelling older men: the CHAMP study. Ann Med. 2016; 49(2): 157–164. PubMed Abstract | Publisher Full Text

[14] 14. Gray SL, Anderson ML, Dublin S, et al.: Cumulative Use of Strong Anticholinergics and Incident Dementia. JAMA Intern Med. 2015; 175(3): 401–7. PubMed Abstract | Publisher Full Text | Free Full Text

[15] 15. Corsonello A, Cozza A, D'Alia S, et al.: The excess mortality risk associated with anticholinergic burden among older patients discharged from acute care hospital with depressive symptoms. Eur J Intern Med. 2019; 61: 69–74. PubMed Abstract | Publisher Full Text

[16] 16. Arksey H, O'Malley L: Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005; 8(1): 19–32. Publisher Full Text

[17] 17. Levac D, Colquhoun H, O'Brien KK: Scoping studies: advancing the methodology. Implement Sci. 2010; 5(1): 69. PubMed Abstract | Publisher Full Text | Free Full Text

[18] 18. The Joanna Briggs Institute: The Joanna Briggs Institute Reviewers’ manual 2015 - methodology for JBI scoping reviews. Adelaide, South Australia, 2015. Reference Source

[19] 19. Shuahimi L: The adverse effects of long-term exposure to anticholinergics among people with intellectual disabilities: a scoping review. Open Science Framework. [Dataset]. 2022. http://www.doi.org/10.17605/OSF.IO/CVZX3

[20] 20. Al Shuhaimi L, Henman M, McCallion P, et al.: The impact of long-term exposure to anticholinergics among people with intellectual disabilities: a scoping review protocol [version 1; peer review: 1 approved with reservations]. HRB Open Res. 2021; 4: 62. Publisher Full Text

[21] 21. O’Connell J, Henman MC, Burke É, et al.: Association of Drug Burden Index with grip strength, timed up and go and Barthel index activities of daily living in older adults with intellectual disabilities: an observational cross-sectional study. BMC Geriatr. 2019; 19(1): 173. PubMed Abstract | Publisher Full Text | Free Full Text

[22] 22. Lang A, Edwards N, Fleiszer A: Empty systematic reviews: hidden perils and lessons learned. J Clin Epidemiol. 2007; 60(6): 595–597. PubMed Abstract | Publisher Full Text

[23] 23. Yaffe J, Montgomery P, Hopewell S, et al.: Empty Reviews: A Description and Consideration of Cochrane Systematic Reviews with No Included Studies. PLoS One. 2012; 7(5): e36626. PubMed Abstract | Publisher Full Text | Free Full Text

[24] 24. Gray R: Empty systematic reviews: Identifying gaps in knowledge or a waste of time and effort? Nurse Author Ed. 2021; 31(2): 42–44. Publisher Full Text

[25] 25. Fox C, Livingston G, Maidment ID, et al.: The impact of anticholinergic burden in Alzheimer's Dementia-the Laser-AD study. Age Ageing. 2011; 40(6): 730–735. PubMed Abstract | Publisher Full Text

[26] 26. Ah YM, Suh Y, Jun K, et al.: Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population‐based study. Basic Clin Pharmacol Toxicol. 2019; 124(6): 741–748. PubMed Abstract | Publisher Full Text

[27] 27. Naharci MI, Cintosun U, Ozturk A, et al.: Effect of anticholinergic burden on the development of dementia in older adults with subjective cognitive decline. Psychiatry and Clinical Psychopharmacology. 2017; 27(3): 263–270. Publisher Full Text

[28] 28. Dyer AH, Murphy C, Segurado R, et al.: Is Ongoing Anticholinergic Burden Associated With Greater Cognitive Decline and Dementia Severity in Mild to Moderate Alzheimer's Disease? J Gerontol A Biol Sci Med Sci. 2020; 75(5): 987–994. PubMed Abstract | Publisher Full Text

[29] 29. Green AR, Reifler LM, Bayliss EA, et al.: Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study. Drugs Aging. 2019; 36(3): 289–297. PubMed Abstract | Publisher Full Text | Free Full Text

The adverse effects of long-term exposure to anticholinergics among people with intellectual disabilities: a scoping review

Abstract

Keywords

Introduction

Methods

Stage 1: Identification of the research question

Stage 2: Identification of relevant studies

Table 1. Search keywords: the table illustrates the terms used for conduction of the search using the electronic databases.

Stage 3: Selection of studies

Figure 1. PRISMA flow chart illustrating the process of study selection.

Stage 6: Consultation

Differences between protocol and review

Stage 2: Identification of relevant studies

Stages 4 and 5: Data charting, collating, summarising and reporting the results

Results

Description of studies

Consultation findings

Discussion

Conclusions

Data availability

Underlying data

Reporting guidelines

References

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Open Peer Review

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The adverse effects of long-term exposure to anticholinergics among people with intellectual disabilities: a scoping review

Abstract

Keywords

Introduction

Methods

Stage 1: Identification of the research question

Stage 2: Identification of relevant studies

Table 1. Search keywords: the table illustrates the terms used for conduction of the search using the electronic databases.

Stage 3: Selection of studies

Figure 1. PRISMA flow chart illustrating the process of study selection.

Stage 6: Consultation

Differences between protocol and review

Stage 2: Identification of relevant studies

Stages 4 and 5: Data charting, collating, summarising and reporting the results

Results

Description of studies

Consultation findings

Discussion

Conclusions

Data availability

Underlying data

Reporting guidelines

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Competing Interests Policy

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