Anticholinergic Burden in People with Intellectual Disabilities

Anticholinergics are medications that inhibit acetylcholine (ACh) at synapses within the central and peripheral nervous systems, consequently reducing parasympathetic activity. They are commonly used to treat conditions like asthma, COPD, Parkinson’s disease, and various mental health disorders. Despite their therapeutic benefits, these drugs are associated with significant adverse effects, including cognitive impairment, which are especially concerning in older adults and individuals with intellectual disabilities. Older adults often receive multiple anticholinergic prescriptions due to a higher prevalence of chronic conditions, leading to an elevated cumulative anticholinergic burden. Similarly, individuals with intellectual disabilities are particularly vulnerable due to a higher incidence of mental and physical health issues, frequent use of psychotropic medications, and increased rates of polypharmacy. This population often experiences higher anticholinergic cognitive burden (ACB), especially those with comorbid epilepsy, psychiatric conditions, and behavioral issues. Several scales, such as the Anticholinergic Cognitive Burden Scale (ACB) and the Anticholinergic Drug Scale (ADS), have been developed to measure the anticholinergic activity of drugs. These tools help in evaluating the cumulative effects of these medications, which include severe cognitive and physical side effects. Central effects encompass memory impairment and cognitive decline, while peripheral effects involve issues like dry mouth, urinary retention, and constipation. Managing anticholinergic burden involves careful prescription oversight, regular monitoring, and possible deprescribing, especially in high-risk groups. It is critical to balance the therapeutic benefits with the potential risks, particularly in older adults and those with intellectual disabilities. Multidisciplinary approaches and ongoing research are essential to optimize the use of anticholinergic medications and mitigate their adverse effects.