New research reveals that a class of drugs prescribed to treat common
conditions ranging from bladder problems, depression and insomnia in up to 50% of
older patients may delay their recovery from brain injury.
Drugs commonly used to treat complications of brain and spinal cord injuries may prolong rehabilitation, a new study suggests.
Anticholinergics are already known to have side effects, including temporary
cognitive impairment, confusion and dizziness. But the new study led by the
University of East Anglia (UEA) in the UK is the first to investigate their effects
on patients with brain injury.
The researchers, including scientists from Aston University, other UK research
centers and the British National Health Service, report their findings in the journal Brain
The study investigated 52 patients who had suffered brain or spinal injury and
were treated at a neuro-rehabilitation unit.
Patients undergoing neuro-rehabilitation are often given anticholinergics to
relieve pain, urinary incontinence and other conditions.
The researchers found that the average length of stay among the patients
they studied was longer for those with higher levels of anticholinergic
drug burden (ACB) in their system.
The analysis showed a direct correlation between changes in ACB and length of
hospital stay. Patients whose ACB scores on discharge were higher than on admission stayed
longer in hospital and patients whose ACB scores on discharge were lower spent less time in hospital on
However, the researchers point out their study was not designed to prove cause
and effect; it can only show there is a link.
Anticholinergic drugs can interfere with rehabilitation
Senior author Chris Fox, a professor of clinical psychiatry at Norwich Medical
School at UEA, says:
“This pilot study demonstrates the need for larger studies to confirm the
results and need for further investigation into what long-term effects these common
medications are having on the recovery of these patients.”
He explains that while it is often necessary to treat common complications of brain
and spinal cord injuries with anticholinergic drugs, medication side effects such
as cognitive impairment can get in the way of patients being able to engage fully
in their rehabilitation, resulting in a longer hospital stay.
Co-author Dr. Ian Maidment, who lectures in clinical pharmacy at Aston’s School
of Life & Health Sciences, says their findings add to the evidence that, where
possible, anticholinergics should be avoided in a wide range of populations.
“Regular medication review by a nurse, doctor or pharmacist may be a way
of ensuring that medicines with anticholinergic effects are used
appropriately,” he suggests.
The study is important not just for clinical reasons but also because one of the
measures of hospital performance is length of stay, and there are financial
incentives for discharging patients as soon as is safe.
Prof. Fox concludes:
“Identifying factors which might adversely affect the length of a
patient’s stay can have important financial as well as quality of life
Therefore, he adds, the study’s findings may help improve wider efficiency of
health care by reducing the time patients spend in rehabilitation.
Earlier this year, Medical News Today also learned of a significant
link between high use of anticholinergic drugs and
increased risk of developing dementia and Alzheimer’s disease in older
Written by Catharine Paddock PhD
Copyright: Medical News Today
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