Anticholinergic load: A commonly neglected and preventable risk to cognition during schizophrenia treatment?

• Published in: Schizophrenia research. Cognition 2024-09, Vol.37, p.100317-100317, Article 100317
• Main Authors: Martínez-Cao, Clara, García-Fernández, Ainoa, González-Blanco, Leticia, Sáiz, Pilar A., Bobes, Julio, García-Portilla, María Paz
• Format: Article
• Language: English
• Subjects: anticholinergic burden; cognition; cognitive deficits; psychopathology; schizophrenia
• ISSN: 2215-0013; 2215-0013
• DOI: 10.1016/j.scog.2024.100317

Cognitive impairment is a widespread feature of schizophrenia, affecting nearly 80 % of patients. Prior research has linked the anticholinergic burden of psychiatric medications to these cognitive deficits. However, the impact of the anticholinergic burden from medications for physical morbidity remains underexplored. This study aimed to evaluate the anticholinergic burden of psychiatric and physical medications in patients with schizophrenia and assess its impact on cognitive function. A total of 178 patients with schizophrenia were recruited. The assessments included an ad hoc questionnaire for collecting demographic and clinical data. Anticholinergic burden was evaluated using the cumulative Drug Burden Index (cDBI) for each participant, and cognitive function was assessed using MATRICS. Psychopathology was measured using the PANSS, CDSS, CAINS, and the CGI-S. Statistical analysis included Student's t-tests, ANOVA, Pearson correlations, and multiple linear regressions. The average cDBI was 1.3 (SD = 0.9). The model developed explained 40.80 % of the variance. The variable with the greatest weight was the cDBI (B = −11.148, p = 0.010). Negative-expression (B = -2.740, p = 0.011) and negative-experiential (B = −1.175, p = 0.030) symptoms were also associated with lower global cognitive score. However, more years of education (B = 5.140, p