Frontiers in Pharmacology (Jun 2024)

Comparative analysis of anticholinergic burden scales to explain iatrogenic cognitive impairment in schizophrenia: results from the multicenter FACE-SZ cohort

  • Nathan Vidal,
  • Nathan Vidal,
  • Paul Roux,
  • Paul Roux,
  • Mathieu Urbach,
  • Mathieu Urbach,
  • Cristobal Belmonte,
  • Cristobal Belmonte,
  • Laurent Boyer,
  • Laurent Boyer,
  • Delphine Capdevielle,
  • Delphine Capdevielle,
  • Delphine Capdevielle,
  • Julie Clauss-Kobayashi,
  • Julie Clauss-Kobayashi,
  • Thierry D’Amato,
  • Thierry D’Amato,
  • Romane Dassing,
  • Romane Dassing,
  • Caroline Dubertret,
  • Caroline Dubertret,
  • Julien Dubreucq,
  • Julien Dubreucq,
  • Guillaume Fond,
  • Guillaume Fond,
  • Roxana-Mihaela Honciuc,
  • Roxana-Mihaela Honciuc,
  • Sylvain Leignier,
  • Sylvain Leignier,
  • Pierre-Michel Llorca,
  • Pierre-Michel Llorca,
  • Jasmina Mallet,
  • Jasmina Mallet,
  • David Misdrahi,
  • David Misdrahi,
  • Baptiste Pignon,
  • Baptiste Pignon,
  • Romain Rey,
  • Romain Rey,
  • Franck Schürhoff,
  • Franck Schürhoff,
  • Arnaud Tessier,
  • Arnaud Tessier,
  • the FACE-SZ (FondaMental Academic Centers of Expertise—Schizophrenia) Group,
  • Christine Passerieux,
  • Christine Passerieux,
  • Eric Brunet-Gouet,
  • Eric Brunet-Gouet,
  • B. Aouizerate,
  • V. Barteau,
  • S. Bensalem,
  • F. Berna,
  • O. Blanc,
  • E. Bourguignon,
  • L. Boyer,
  • D. CapdevielleI. Chéreau,
  • G. Chesnoy-Servanin,
  • T. D’Amato,
  • A. Deloge,
  • H. Denizot,
  • JM. Dorey,
  • C. Dubertret,
  • J. Dubreucq,
  • S. Esselin,
  • C. Faget,
  • C. Fluttaz,
  • G. Fond,
  • F. Gabayet,
  • O. Godin,
  • E. Haffen,
  • RM. Honciuc,
  • M. Jarroir,
  • D. Lacelle,
  • C. Lançon,
  • H. Laouamri,
  • M. Leboyer,
  • PM Llorca,
  • J. Mallet,
  • E. Metairie,
  • D. Misdrahi,
  • C. Passerieux,
  • J. Petrucci,
  • P. Peri,
  • B. Pignon,
  • S. Pires,
  • C. Portalier,
  • R. Rey,
  • C. Roman,
  • F. Schürhoff,
  • K. Souryis,
  • A. Szöke,
  • M. Urbach,
  • F. Vaillant,
  • A,
  • Vehier,
  • P. Vidailhet,
  • E. Vilà,
  • G. Wahiche,
  • H. Yazbek,
  • A. Zinetti-Bertschy

DOI
https://doi.org/10.3389/fphar.2024.1403093
Journal volume & issue
Vol. 15

Abstract

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AimThe anticholinergic properties of medications are associated with poorer cognitive performance in schizophrenia. Numerous scales have been developed to assess anticholinergic burden and yet, there is no consensus indicating which anticholinergic burden scale is more relevant for patients with schizophrenia. We aimed to identify valid scales for estimating the risk of iatrogenic cognitive impairment in schizophrenia.MethodsWe identified 27 scales in a literature review. The responses to neuropsychological tests of 839 individuals with schizophrenia or schizoaffective disorder in the FACE-SZ database were collected between 2010 and 2021. We estimated the association between objective global cognitive performance and the 27 scales, the number of psychotropic drugs, and chlorpromazine and lorazepam equivalents in bivariable regressions in a cross-sectional design. We then adjusted the bivariable models with covariates: the predictors significantly associated with cognitive performance in multiple linear regressions were considered to have good concurrent validity to assess cognitive performance.ResultsEight scales, the number of psychotropic drugs, and drug equivalents were significantly associated with cognitive impairment. The number of psychotropic drugs, the most convenient predictor to compute, was associated with worse executive function (Standardized β = −0.12, p = .004) and reasoning (Standardized β = −0.08, p = .037).ConclusionAnticholinergic burden, the number of psychotropic drugs, and drug equivalents were weakly associated with cognition, thus suggesting that cognitive impairment in schizophrenia and schizoaffective disorder is explained by factors other than medication. The number of psychotropic drugs was the most parsimonious method to assess the risk of iatrogenic cognitive impairment.

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