New Risk Score Predicts Risk for Anticholinergic Adverse Effects. Mescape Today,March 11, 2008. Higher Anticholinergic Risk Scale (ARS) scores are associated with statistically significantly increased risk for anticholinergic adverse effects in older patients, according to the results of a study reported in the March 10 issue of the Archives of Internal Medicine."Adverse effects of anticholinergic medications may contribute to events such as falls, delirium, and cognitive impairment in older patients," write James L. Rudolph, MD, SM, from the Geriatric Research, Education, and Clinical Center, Veterans Affairs Boston Healthcare System in Boston and colleagues. "To further assess this risk, we developed the Anticholinergic Risk Scale (ARS), a ranked categorical list of commonly prescribed medications with anticholinergic potential. The objective of this study was to determine if the ARS score could be used to predict the risk of anticholinergic adverse effects in a geriatric evaluation and management (GEM) cohort and in a primary care cohort." [ See , previous log in). See abstract in Read More

The Anticholinergic Risk Scale and Anticholinergic Adverse Effects in Older Persons. James L. Rudolph, MD, SM; Marci J. Salow, PharmD; Michael C. Angelini, MA, PharmD; Regina E. McGlinchey, PhD .Arch Intern Med. 2008;168(5):508-513. Background  Adverse effects of anticholinergic medications may contribute to events such as falls, delirium, and cognitive impairment in older patients. To further assess this risk, we developed the Anticholinergic Risk Scale (ARS), a ranked categorical list of commonly prescribed medications with anticholinergic potential. The objective of this study was to determine if the ARS score could be used to predict the risk of anticholinergic adverse effects in a geriatric evaluation and management (GEM) cohort and in a primary care cohort. Methods  Medical records of 132 GEM patients were reviewed retrospectively for medications included on the ARS and their resultant possible anticholinergic adverse effects. Prospectively, we enrolled 117 patients, 65 years or older, in primary care clinics; performed medication reconciliation; and asked about anticholinergic adverse effects. The relationship between the ARS score and the risk of anticholinergic adverse effects was assessed using Poisson regression analysis. Results  Higher ARS scores were associated with increased risk of anticholinergic adverse effects in the GEM cohort (crude relative risk [RR], 1.5; 95% confidence interval [CI], 1.3-1.8) and in the primary care cohort (crude RR, 1.9; 95% CI, 1.5-2.4). After adjustment for age and the number of medications, higher ARS scores increased the risk of anticholinergic adverse effects in the GEM cohort (adjusted RR, 1.3; 95% CI, 1.1-1.6; c statistic, 0.74) and in the primary care cohort (adjusted RR, 1.9; 95% CI, 1.5-2.5; c statistic, 0.77). Conclusion  Higher ARS scores are associated with statistically significantly increased risk of anticholinergic adverse effects in older patients.