Presented at the 2013 AAPM Annual Meeting « Back

The Relationship Between Anticholinergic Burden and Neuropsychological Functioning in Chronic Pain Patients

Cady K. Block, MS, cblock@uab.edu¹, Leanne R. Cianfrini, PhD², Juliette Galindo, MA¹, Daniel M. Doleys, PhD³, (1) University of Alabama at Birmingham, Hoover, Alabama, (2) The Doleys Clinic, Birmingham, Alabama, (3) Pain and Rehabilitation Institute, Birmingham, Alabama

Introduction: Recent elderly cohort studies1 associate neuropsychological dysfunction with use of medications that have anticholinergic properties. Chronic pain patients (CPPs) use multiple prescription and over-the-counter medications; however, no studies have explicitly examined the relationship between anticholinergic burden and cognition in this population. Materials/Methods: Study approved by the UAB IRB, with recruitment involving electronic/print advertisements in the community and local outpatient medical clinics. Sixty participants (30 pain-free controls, 29 chronic nociceptive CPPs not using opioids) completed a neuropsychological battery. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden (ACB) Scale2. Results: Controlling for demographics, CPPs possessed a significantly higher ACB score (M=1.52, SD=1.88) than controls (M=0.36, SD=0.80), p<0.01. Surprisingly, individuals between the ages of 30-39 had the highest ACB score. While the average number of medications approximated that of older adults in our sample (3.66 vs. 4.02), the medications more frequently possessed anticholinergic properties. The only significant relationship with neuropsychological measures involved perseverative errors on the Wisconsin Card Sorting Test-64 in CPPs with higher ACB versus controls (low vs. high average ranges of performance, respectively; p<0.01). Conclusions: Given the prevalence of polypharmacy in CPPs, providers should be aware of anticholinergic burden and its potential effects on neuropsychological function across all age ranges. Our results indicate that CPPs, even without opioid therapy, do have an increased anticholinergic burden. However, a larger sample size is needed to accurately ascertain neuropsychological implications. References: 1)Campbell N, Boustani M, Limbil T, Ott C, et al. The cognitive impact of anticholinergics: a clinical review. Clinical Interventions in Aging. 2009;4(1):225-33. 2)Boustani MA, Campbell NL, Munger S, Maidment I, Fox GC. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health.2008;4(3):311-20.

Funding: This study was funded by an investigator-initiated study grant by Cephalon, Inc.