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The Canadian Journal of Urology Aug 2021INTRODUCTION Urinary incontinence (UI) is a common condition in all demographics of women and consists of stress UI (SUI), Urgency UI (UUI), and mixed UI (MUI).... (Review)
Review
UNLABELLED
INTRODUCTION Urinary incontinence (UI) is a common condition in all demographics of women and consists of stress UI (SUI), Urgency UI (UUI), and mixed UI (MUI). Treatment includes lifestyle modifications, medical treatment, and surgery depending on the type of UI and severity of symptoms. This review is an update on the evaluation and management of UI in women.
MATERIALS AND METHODS
This review article covers the evaluation and management options for UI in women and includes the most recent guidelines from the American Urological Association (AUA) as well as recently published literature on the management of UI.
RESULTS
Any evaluation of UI should include a thorough targeted history and physical, and counseling for treatment should consider patient goals and desired outcomes. For both SUI and UUI, behavioral therapy and lifestyle modifications are effective first line treatments. Patients with UUI can benefit from medical therapy which includes anticholinergics and ß3-agonist medications, as well as neuromodulation in treatment refractory patients. SUI patients may further benefit from mechanical inserts which prevent leaks, urethral bulking agents, and surgical treatments such as the mid urethral sling and autologous fascial pubovaginal sling.
CONCLUSIONS
Treatment of UI in women requires a graded approach that considers patient goals and symptom severity, beginning with lifestyle and behavioral modifications before progressing to more aggressive interventions.
Topics: Cholinergic Antagonists; Female; Humans; Suburethral Slings; Urinary Incontinence; Urinary Incontinence, Stress; Urinary Incontinence, Urge
PubMed: 34453426
DOI: No ID Found -
Neuroscience and Biobehavioral Reviews Aug 2021Dementia is one of the greatest global challenges for public health; however, the relationship between anticholinergic drugs and dementia remains unclear. The aim of the... (Meta-Analysis)
Meta-Analysis Review
Dementia is one of the greatest global challenges for public health; however, the relationship between anticholinergic drugs and dementia remains unclear. The aim of the present study was to perform a systematic review and meta-analysis of the predictive roles of anticholinergic drugs in dementia risk. After pooling fourteen longitudinal and case-control studies with a total of 1,564,181 subjects, anticholinergic drug use was associated with an increased risk of all-cause dementia and Alzheimer's disease. Both low and high anticholinergic drug burdens were associated with dementia. Moreover, there was a dose-dependent relationship between anticholinergic drugs and risk of dementia. With respect to the categories of anticholinergic drugs, antiparkinson, urological drugs, and antidepressants increased the risk for dementia; however, cardiovascular and gastrointestinal drugs played potentially protective roles. These findings underscore the importance of anticholinergic drugs as a potential modifiable risk factor for dementia and provide treatment priorities to optimize dementia prevention.
Topics: Alzheimer Disease; Cholinergic Antagonists; Dementia; Humans; Pharmaceutical Preparations; Risk Factors
PubMed: 33933505
DOI: 10.1016/j.neubiorev.2021.04.031 -
Journal of the American Medical... Jan 2021To investigate the association between anticholinergic drug burden (ADB), measured with anticholinergic drug scales, and delirium and delirium severity. (Review)
Review
OBJECTIVES
To investigate the association between anticholinergic drug burden (ADB), measured with anticholinergic drug scales, and delirium and delirium severity.
DESIGN
Systematic review.
SETTING AND PARTICIPANTS
All available studies.
METHODS
A systematic literature search was performed in Medline, Embase, PsycINFO, Web of Science, CINAHL, Cochrane library, and Google Scholar. Studies evaluating the association between ADB (measured as a total score) and delirium or delirium severity, published in English, were eligible for inclusion.
RESULTS
Sixteen studies, including 148,756 persons, were included. Fifteen studies investigated delirium. ADB was measured with the Anticholinergic Risk Scale (ARS, n = 5), the Anticholinergic Cognitive Burden Scale (ACB, n = 6), the list of Chew (n = 1), the Anticholinergic Drug Scale (ADS, n = 5), a modified version of the ARS (n = 1), and a modified version of the ACB (n = 1). A high ADB, measured with the ARS, was associated with delirium (5/5). Also with the modified version of the ARS and ACB, an association was found between a high ADB and delirium during 3-month (1/1) and 1-year follow-up (1/1), respectively. When ADB was assessed with other scales, the results were inconclusive, with only 1 positive association for the ACB (1/6) and ADS (1/5) each. The possible association between ADB and delirium severity has also been investigated (ADS n = 2, Summers Drug Risk Number n = 1). One study found an association between a high ADB, measured with the ADS, and an increase in severity of delirium.
CONCLUSIONS AND IMPLICATIONS
ADB assessed with the ARS is consistently associated with delirium. The association found between the modified versions of the ARS and ACB and delirium needs confirmation. When ADB was assessed with other scales, the findings were inconclusive. The current findings suggest that the ARS might be a useful tool to identify patients at increased risk for delirium.
Topics: Cholinergic Antagonists; Delirium; Humans; Pharmaceutical Preparations
PubMed: 32703688
DOI: 10.1016/j.jamda.2020.04.019 -
European Psychiatry : the Journal of... Sep 2022Although cognitive impairment is a core symptom of schizophrenia related to poorer outcomes in different functional domains, it still remains a major therapeutic... (Review)
Review
BACKGROUND
Although cognitive impairment is a core symptom of schizophrenia related to poorer outcomes in different functional domains, it still remains a major therapeutic challenge. To date, no comprehensive treatment guidelines for cognitive impairment in schizophrenia are implemented.
METHODS
The aim of the present guidance paper is to provide a comprehensive meta-review of the current available evidence-based treatments for cognitive impairment in schizophrenia. The guidance is structured into three sections: pharmacological treatment, psychosocial interventions, and somatic treatments.
RESULTS
Based on the reviewed evidence, this European Psychiatric Association guidance recommends an appropriate pharmacological management as a fundamental starting point in the treatment of cognitive impairment in schizophrenia. In particular, second-generation antipsychotics are recommended for their favorable cognitive profile compared to first-generation antipsychotics, although no clear superiority of a single second-generation antipsychotic has currently been found. Anticholinergic and benzodiazepine burdens should be kept to a minimum, considering the negative impact on cognitive functioning. Among psychosocial interventions, cognitive remediation and physical exercise are recommended for the treatment of cognitive impairment in schizophrenia. Noninvasive brain stimulation techniques could be taken into account as add-on therapy.
CONCLUSIONS
Overall, there is definitive progress in the field, but further research is needed to develop specific treatments for cognitive impairment in schizophrenia. The dissemination of this guidance paper may promote the development of shared guidelines concerning the treatment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to achieve recovery in this population.
Topics: Antipsychotic Agents; Benzodiazepines; Cholinergic Antagonists; Cognitive Dysfunction; Humans; Schizophrenia; Schizophrenic Psychology
PubMed: 36059103
DOI: 10.1192/j.eurpsy.2022.2315 -
The American Journal of Psychiatry Sep 2021Many psychotropic medications used to treat schizophrenia have significant anticholinergic properties, which are linked to cognitive impairment and dementia risk in...
OBJECTIVE
Many psychotropic medications used to treat schizophrenia have significant anticholinergic properties, which are linked to cognitive impairment and dementia risk in healthy subjects. Clarifying the impact of cognitive impairment attributable to anticholinergic medication burden may help optimize cognitive outcomes in schizophrenia. The aim of this study was to comprehensively characterize how this burden affects functioning across multiple cognitive domains in schizophrenia outpatients.
METHODS
Cross-sectional data were analyzed using inferential statistics and exploratory structural equation modeling to determine the relationship between anticholinergic medication burden and cognition. Patients with a diagnosis of schizophrenia or schizoaffective disorder (N=1,120) were recruited from the community at five U.S. universities as part of the Consortium on the Genetics of Schizophrenia-2. For each participant, prescribed medications were rated and summed according to a modified Anticholinergic Cognitive Burden (ACB) scale. Cognitive functioning was assessed by performance on domains of the Penn Computerized Neurocognitive Battery (PCNB).
RESULTS
ACB score was significantly associated with cognitive performance, with higher ACB groups scoring worse than lower ACB groups on all domains tested on the PCNB. Similar effects were seen on other cognitive tests. Effects remained significant after controlling for demographic characteristics and potential proxies of illness severity, including clinical symptoms and chlorpromazine-equivalent antipsychotic dosage.
CONCLUSIONS
Anticholinergic medication burden in schizophrenia is substantial, common, conferred by multiple medication classes, and associated with cognitive impairments across all cognitive domains. Anticholinergic medication burden from all medication classes-including psychotropics used in usual care-should be considered in treatment decisions and accounted for in studies of cognitive functioning in schizophrenia.
Topics: Adolescent; Adult; Aged; Cholinergic Antagonists; Cognition; Cognitive Dysfunction; Cohort Studies; Cross-Sectional Studies; Humans; Middle Aged; Neuropsychological Tests; Schizophrenia; Young Adult
PubMed: 33985348
DOI: 10.1176/appi.ajp.2020.20081212 -
Journal of Drugs in Dermatology : JDD May 2021Hyperhidrosis (HH) is defined as perspiration beyond the level required to maintain temperature regulation. HH affects nearly 4.8% of the population in the United... (Review)
Review
Hyperhidrosis (HH) is defined as perspiration beyond the level required to maintain temperature regulation. HH affects nearly 4.8% of the population in the United States. It can have a great impact on patient’s quality of life by disturbing daily activity, performance, confidence, social interactions, and mental health. In the majority of patients with HH (93%), the etiology of excess sweating is idiopathic, which classifies it as primary focal HH. Mild HH may be controlled with topical antiperspirants and lifestyle modifications. Based on the location of involvement, iontophoresis and botulinum toxin may be considered if the patient does not respond to topical therapies. Despite minimizing sweating, chronic use of systemic anticholinergics, in particular oxybutynin, may result in detrimental adverse effects such as dementia. Local surgery, radiofrequency, microwave, and lasers are other potential modalities for HH. Sympathectomy can be a last resort for the treatment of focal HH of the palmar, plantar, axillary, and craniofacial areas after failure of less invasive therapeutic options. In this review, we conducted a comprehensive search in the PubMed electronic database to summarize an algorithmic approach for the treatment of HH. This can help broaden options for managing this difficult disease. J Drugs Dermatol. 20(5): doi:10.36849/JDD.5774.
Topics: Antiperspirants; Botulinum Toxins, Type A; Cholinergic Antagonists; Combined Modality Therapy; Dermatology; Humans; Hyperhidrosis; Iontophoresis; Laser Therapy; Practice Guidelines as Topic; Quality of Life; Radiofrequency Therapy; Severity of Illness Index; Sweat Glands; Sympathectomy; Treatment Outcome
PubMed: 33938689
DOI: 10.36849/JDD.5774 -
International Journal of Dermatology Nov 2022Primary palmar hyperhidrosis (PH) can have a significantly negative impact on an individual's quality of life. Currently, there appears to be no review of the... (Review)
Review
BACKGROUND
Primary palmar hyperhidrosis (PH) can have a significantly negative impact on an individual's quality of life. Currently, there appears to be no review of the effectiveness of the different interventions for its management.
METHODS
A systematic review was performed using PRISMA guidelines, the Cochrane Database, and MEDLINE (OVID) to identify relevant studies published from 1997 to 2017.
RESULTS
Of the 574 references yielded, six met the inclusion criteria and were analyzed for this review. Two studies evaluated the use of oral oxybutynin as an anticholinergic treatment for PH; this demonstrated high efficacy with over 80% of patients reporting symptom improvement; dry mouth was the most common adverse effect reported. One study looking at the use of iontophoresis reported 81% improvement in patients' symptoms. One randomized, double-blind, trial looked at the use of botulinum toxin A injections for the treatment of PH; it reported 90% of patients experienced an improvement in PH. The remaining two studies evaluated the use of endoscopic thoracic sympathectomy (ETS) in PH, and both reported over 95% patient symptom improvement.
CONCLUSION
There are few good quality studies evaluating the treatment of primary PH. Based on the little available evidence, the interventions reviewed significantly improve the symptoms of PH. Anticholinergic medications are considered effective and safe. Both iontophoresis and botulinum toxin provided patients with symptom relief when administered regularly. ETS was reported as successful in the reduction of PH, however, it carries significant adverse effects such as compensatory sweating and the potential of complications associated with surgery.
Topics: Botulinum Toxins, Type A; Cholinergic Antagonists; Humans; Hyperhidrosis; Patient Satisfaction; Quality of Life; Randomized Controlled Trials as Topic; Sympathectomy; Treatment Outcome
PubMed: 34653261
DOI: 10.1111/ijd.15937 -
The New England Journal of Medicine Feb 2021The muscarinic receptor agonist xanomeline has antipsychotic properties and is devoid of dopamine receptor-blocking activity but causes cholinergic adverse events.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The muscarinic receptor agonist xanomeline has antipsychotic properties and is devoid of dopamine receptor-blocking activity but causes cholinergic adverse events. Trospium is a peripherally restricted muscarinic receptor antagonist that reduces peripheral cholinergic effects of xanomeline. The efficacy and safety of combined xanomeline and trospium in patients with schizophrenia are unknown.
METHODS
In this double-blind, phase 2 trial, we randomly assigned patients with schizophrenia in a 1:1 ratio to receive twice-daily xanomeline-trospium (increased to a maximum of 125 mg of xanomeline and 30 mg of trospium per dose) or placebo for 5 weeks. The primary end point was the change from baseline to week 5 in the total score on the Positive and Negative Syndrome Scale (PANSS; range, 30 to 210, with higher scores indicating more severe symptoms of schizophrenia). Secondary end points were the change in the PANSS positive symptom subscore, the score on the Clinical Global Impression-Severity (CGI-S) scale (range, 1 to 7, with higher scores indicating greater severity of illness), the change in the PANSS negative symptom subscore, the change in the PANSS Marder negative symptom subscore, and the percentage of patients with a response according to a CGI-S score of 1 or 2.
RESULTS
A total of 182 patients were enrolled, with 90 assigned to receive xanomeline-trospium and 92 to receive placebo. The PANSS total score at baseline was 97.7 in the xanomeline-trospium group and 96.6 in the placebo group. The change from baseline to week 5 was -17.4 points with xanomeline-trospium and -5.9 points with placebo (least-squares mean difference, -11.6 points; 95% confidence interval, -16.1 to -7.1; P<0.001). The results for the secondary end points were significantly better in the xanomeline-trospium group than in the placebo group, with the exception of the percentage of patients with a CGI-S response. The most common adverse events in the xanomeline-trospium group were constipation, nausea, dry mouth, dyspepsia, and vomiting. The incidences of somnolence, weight gain, restlessness, and extrapyramidal symptoms were similar in the two groups.
CONCLUSIONS
In a 5-week trial, xanomeline-trospium resulted in a greater decrease in the PANSS total score than placebo but was associated with cholinergic and anticholinergic adverse events. Larger and longer trials are required to determine the efficacy and safety of xanomeline-trospium in patients with schizophrenia. (Funded by Karuna Therapeutics and the Wellcome Trust; ClinicalTrials.gov number, NCT03697252.).
Topics: Administration, Oral; Adult; Antipsychotic Agents; Benzilates; Cholinergic Antagonists; Double-Blind Method; Drug Combinations; Female; Humans; Least-Squares Analysis; Male; Middle Aged; Muscarinic Agonists; Nortropanes; Pyridines; Schizophrenia; Thiadiazoles
PubMed: 33626254
DOI: 10.1056/NEJMoa2017015 -
BMJ (Clinical Research Ed.) Sep 2023To evaluate the association between recently raised anticholinergic burden and risk of acute cardiovascular events in older adults.
OBJECTIVE
To evaluate the association between recently raised anticholinergic burden and risk of acute cardiovascular events in older adults.
DESIGN
Case-case-time-control study (ie, incorporating a case crossover design and a control crossover design consisting of future cases).
SETTING
Taiwan's National Health Insurance Research Database.
PARTICIPANTS
317 446 adults aged ≥65 who were admitted to hospital because of an incident acute cardiovascular event between 2011 and 2018. Acute cardiovascular events included myocardial infarction, strokes, arrhythmias, conduction disorders, and cardiovascular death.
MAIN OUTCOME MEASURES
The anticholinergic burden was measured for each participant by adding up the anticholinergic scores for individual drugs using the Anticholinergic Cognitive Burden Scale. Scores were classified into three levels (0 points, 1-2 points, and ≥3 points). For each participant, anticholinergic burden levels during hazard periods (day -1 to -30 before the cardiovascular event) were compared with randomly selected 30 day reference periods (ie, periods between days -61 and -180). Conditional logistic regression determined odds ratios with 95% confidence intervals to evaluate the association between acute cardiovascular events and recently raised anticholinergic burden.
RESULTS
The crossover analyses included 248 579 current cases. Participants' average age on the index date was 78.4 years (standard deviation 0.01), and 53.4% were men. The most frequently prescribed drugs with anticholinergic activity were antihistamines (68.9%), gastrointestinal antispasmodics (40.9%), and diuretics (33.8%). Among patients with varying levels of anticholinergic burden in different periods, more patients carried higher levels of anticholinergic burden during hazard periods than during reference periods. For example, 17 603 current cases had 1-2 points of anticholinergic burden in the hazard period with 0 points in the reference period, while 8507 current cases had 0 points in the hazard period and 1-2 points in the reference period. In the comparison of 1-2 points versus 0 points of anticholinergic burden, the odds ratio was 1.86 (95% confidence interval 1.83 to 1.90) in the case crossover analysis and 1.35 (1.33 to 1.38) in the control crossover analysis, which yielded a case-case-time-control odds ratio of 1.38 (1.34 to 1.42). Similar results were found in the comparison of ≥3 versus 0 points (2.03, 1.98 to 2.09) and ≥3 versus 1-2 points (1.48, 1.44 to 1.52). The findings remained consistent throughout a series of sensitivity analyses (eg, cut-off points for anticholinergic burden categories were redefined and different scales were used to measure anticholinergic burden).
CONCLUSIONS
An association was found between recently raised anticholinergic burden and increased risk of acute cardiovascular events. Furthermore, a greater increase in anticholinergic burden was associated with a higher risk of acute cardiovascular events.
Topics: Male; Humans; Aged; Female; Cholinergic Antagonists; Case-Control Studies; Hospitalization; Hospitals; Myocardial Infarction
PubMed: 37758279
DOI: 10.1136/bmj-2023-076045 -
Nederlands Tijdschrift Voor Geneeskunde Nov 2023In this Clinical Lesson, using two illustrating cases, we explain how to do the initial assessment and treatment of an intoxicated patient. An approach aimed at...
In this Clinical Lesson, using two illustrating cases, we explain how to do the initial assessment and treatment of an intoxicated patient. An approach aimed at toxidromes can serve as a stepping stone. A toxidrome is a combination of symptoms and clinical features that can occur with the use of certain drugs and substances. The most commonly encountered toxidromes are sympathomimetic, serotonergic, anticholinergic, cholinergic, sedative-hypnotic and opioid. All patients need to be approach according to the ABCDE method. The treatment is based on pharmacokinetics by means of the ADME principle (absorption, distribution, metabolism and excretion) and based on pharmacodynamics, aimed at the toxidrome.
Topics: Humans; Analgesics, Opioid; Autonomic Nervous System Diseases; Cholinergic Antagonists; Hypnotics and Sedatives
PubMed: 38175605
DOI: No ID Found