Reducing Anticholinergic Burden (ACB) by Deprescribing Antipsychotics for Behavioural and Psychological Symptoms of Dementia

Introduction:  

Many antipsychotics contribute to anticholinergic side effects, including confusion, cognitive decline, and increased dementia risk. Reducing antipsychotics in behavioural and psychological symptoms of dementia (BPSD) may lower these risks and is a priority in Bradford District and Craven.

Method:

Care home residents taking antipsychotics for BPSD were identified by a mental health nurse in conjunction with care home staff in a larger yearlong deprescribing project. Appropriate residents were enrolled into a deprescribing protocol. The deprescribing regime was communicated to their General Practitioner (GP), next of kin and care home staff. Follow up monitoring was provided by the care home liaison team. For residents where deprescribing was successful the anticholinergic burden (ACB) using ACB Calculator of the antipsychotics were recorded to evidence potential reduction in ACB score.

Results:

86 residents on antipsychotics were identified. Deprescribing was initiated in 58 residents.

35 out of 58 (60%) had the antipsychotic successfully deprescribed with no reemergence of BPSD.

Of these 35 residents where antipsychotics were deprescribed successfully ACB was calculated:

18 (51%) had an antipsychotic with an ACB score of 3 deprescribed 

15 (43%) had an antipsychotic with an ACB score of 1 deprescribed 

2 (6%) had an antipsychotic with an ACB score of 0 deprescribed.

12 of the 58 residents (21%) had the antipsychotic dose reduced but it not withdrawn completely. This reduction in dose did not represent a reduction in the overall ACB scores but is recognised as reducing anticholinergic effects.

11 of the 58 residents (19%) remained on antipsychotics due to re-emergence of BPSD.

Conclusion:

Deprescribing or reducing antipsychotics in BPSD has potential to reduce anticholinergic side effects.

This study is part of a system wide approach to tackle antipsychotic overprescribing in BPSD in Bradford District and Craven, through stakeholder engagement and evaluation of prescribing habits in addition to deprescribing.