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Effects of Anticholinergic Burden on Verbal Memory Performance in First-Episode Psychosis

OBJECTIVES: Antipsychotics are widely used to treat first-episode psychosis but may have an anticholinergic burden, that is, a cumulative effect of medications that block the cholinergic system. Studies suggest that a high anticholinergic burden negatively affects memory in psychosis, where cognitiv...

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Autores principales: Belkacem, Agnès, Lavigne, Katie M., Makowski, Carolina, Chakravarty, Mallar, Joober, Ridha, Malla, Ashok, Shah, Jai, Lepage, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657580/
https://www.ncbi.nlm.nih.gov/pubmed/37254533
http://dx.doi.org/10.1177/07067437231179161
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author Belkacem, Agnès
Lavigne, Katie M.
Makowski, Carolina
Chakravarty, Mallar
Joober, Ridha
Malla, Ashok
Shah, Jai
Lepage, Martin
author_facet Belkacem, Agnès
Lavigne, Katie M.
Makowski, Carolina
Chakravarty, Mallar
Joober, Ridha
Malla, Ashok
Shah, Jai
Lepage, Martin
author_sort Belkacem, Agnès
collection PubMed
description OBJECTIVES: Antipsychotics are widely used to treat first-episode psychosis but may have an anticholinergic burden, that is, a cumulative effect of medications that block the cholinergic system. Studies suggest that a high anticholinergic burden negatively affects memory in psychosis, where cognitive deficits, particularly those in verbal memory, are a core feature of the disease. The present study sought to replicate this in a large cohort of well-characterized first-episode psychosis patients. We expected that patients in the highest anticholinergic burden group would exhibit the poorest verbal memory compared to those with low anticholinergic burden and healthy controls at baseline (3 months following admission). We further hypothesized that over time, at month 12, patients’ verbal memory performance would improve but would remain inferior to controls. METHODS: Patients (n  =  311; low anticholinergic burden [n  =  241] and high anticholinergic burden [n  =  70], defined by a Drug Burden Index cut-off of 1) and healthy controls (n  =  128) completed a clinical and neurocognitive battery including parts of the Wechsler Memory Scale at months 3 and 12. RESULTS: Cross-sectionally, using an analysis of variance, patients in the highest anticholinergic burden group had the poorest performance in verbal memory when compared to the other groups at month 3, F(2,430)  =  52.33, P < 0.001. Longitudinally, using a Generalized Estimating Equation model, the verbal memory performance of all groups improved over time. However, patients’ performance overall remained poorer than the controls. CONCLUSION: These findings highlight the importance of considering the anticholinergic burden when prescribing medications in the early stages of the disease.
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spelling pubmed-106575802023-05-30 Effects of Anticholinergic Burden on Verbal Memory Performance in First-Episode Psychosis Belkacem, Agnès Lavigne, Katie M. Makowski, Carolina Chakravarty, Mallar Joober, Ridha Malla, Ashok Shah, Jai Lepage, Martin Can J Psychiatry Original Research OBJECTIVES: Antipsychotics are widely used to treat first-episode psychosis but may have an anticholinergic burden, that is, a cumulative effect of medications that block the cholinergic system. Studies suggest that a high anticholinergic burden negatively affects memory in psychosis, where cognitive deficits, particularly those in verbal memory, are a core feature of the disease. The present study sought to replicate this in a large cohort of well-characterized first-episode psychosis patients. We expected that patients in the highest anticholinergic burden group would exhibit the poorest verbal memory compared to those with low anticholinergic burden and healthy controls at baseline (3 months following admission). We further hypothesized that over time, at month 12, patients’ verbal memory performance would improve but would remain inferior to controls. METHODS: Patients (n  =  311; low anticholinergic burden [n  =  241] and high anticholinergic burden [n  =  70], defined by a Drug Burden Index cut-off of 1) and healthy controls (n  =  128) completed a clinical and neurocognitive battery including parts of the Wechsler Memory Scale at months 3 and 12. RESULTS: Cross-sectionally, using an analysis of variance, patients in the highest anticholinergic burden group had the poorest performance in verbal memory when compared to the other groups at month 3, F(2,430)  =  52.33, P < 0.001. Longitudinally, using a Generalized Estimating Equation model, the verbal memory performance of all groups improved over time. However, patients’ performance overall remained poorer than the controls. CONCLUSION: These findings highlight the importance of considering the anticholinergic burden when prescribing medications in the early stages of the disease. SAGE Publications 2023-05-30 2023-12 /pmc/articles/PMC10657580/ /pubmed/37254533 http://dx.doi.org/10.1177/07067437231179161 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research
Belkacem, Agnès
Lavigne, Katie M.
Makowski, Carolina
Chakravarty, Mallar
Joober, Ridha
Malla, Ashok
Shah, Jai
Lepage, Martin
Effects of Anticholinergic Burden on Verbal Memory Performance in First-Episode Psychosis
title Effects of Anticholinergic Burden on Verbal Memory Performance in First-Episode Psychosis
title_full Effects of Anticholinergic Burden on Verbal Memory Performance in First-Episode Psychosis
title_fullStr Effects of Anticholinergic Burden on Verbal Memory Performance in First-Episode Psychosis
title_full_unstemmed Effects of Anticholinergic Burden on Verbal Memory Performance in First-Episode Psychosis
title_short Effects of Anticholinergic Burden on Verbal Memory Performance in First-Episode Psychosis
title_sort effects of anticholinergic burden on verbal memory performance in first-episode psychosis
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657580/
https://www.ncbi.nlm.nih.gov/pubmed/37254533
http://dx.doi.org/10.1177/07067437231179161
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