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The Anticholinergic Drug Scale as a Measure of Drug-Related Anticholinergic Burden: Associations With Serum Anticholinergic Activity

From the University of Oklahoma College of Pharmacy, Department of Pharmacy: Clinical and Administrative Sciences, Tulsa, Oklahoma (Dr Carnahan); Laureate Psychiatric Research Center, Tulsa, Oklahoma (Dr Lund); Touro University—California College of Pharmacy, Vallejo, California (Dr Perry); the University of Iowa Roy J. and Lucille A. Carver College of Medicine, Department of Psychiatry, Iowa City, Iowa (Dr Perry); Rotman Research Institute, Baycrest Centre for Geriatric Care, University of Toronto, Toronto, Ontario, Canada (Dr Pollock); the University of Iowa College of Nursing, Iowa City, Iowa (Dr Culp).

Anticholinergic Drug Scale (ADS) scores were previously associated with serum anticholinergic activity (SAA) in a pilot study. To replicate these results, the association between ADS scores and SAA was determined using simple linear regression in subjects from a study of delirium in 201 long-term care facility residents who were not included in the pilot study. Simple and multiple linear regression models were then used to determine whether the ADS could be modified to more effectively predict SAA in all 297 subjects. In the replication analysis, ADS scores were significantly associated with SAA (R² = .0947, P < .0001). In the modification analysis, each model significantly predicted SAA, including ADS scores (R² = .0741, P < .0001). The modifications examined did not appear useful in optimizing the ADS. This study replicated findings on the association of the ADS with SAA. Future work will determine whether the ADS is clinically useful for preventing anticholinergic adverse effects.

Key Words: Anticholinergics • serum anticholinergic activity • Anticholinergic Drug Scale

Address for reprints: Ryan Carnahan, PharmD, the University of Oklahoma College of Pharmacy, 4502 E. 41st Street, Suite 2H19, Tulsa, Oklahoma 74315-2512; e-mail: ryan-carnahan{at}ouhsc.edu.

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