The University of Exeter and Kent, in collaboration with Medway NHS and Social Care Partnership Trust, have headed a study to test a new instrument designed to measure which medicines have a high chance of having extreme anticholinergic effects on the brain and body. This study was published in Age and Ageing.
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Several prescribed and over-the-counter medicines can cause complications and affect the brain by blocking an important neurotransmitter known as acetylcholine. Some degree of anticholinergic influence can be found in several types of drugs, such as some medications for the bladder and stomach, as well as Parkinson’s disease and anti-depressants. These drugs are most commonly consumed by the elderly.
Some of the anticholinergic side effects are blurred vision, confusion, falls, a decline in brain activity, and dizziness. Anticholinergic influences might also raise the risks of falls and might be related to a rise in death. When used long term, they are also known to increase the risk of dementia.
Scientists have now built a tool to measure the harmful effects of drugs using artificial intelligence (AI). The research team developed an online tool called International Anticholinergic Cognitive Burden Tool (IACT), an AI approach that employs natural language processing and chemical structure investigation to detect drugs likely to carry an anticholinergic effect.
The tool is the first to include a machine learning approach to build an automatically updated tool that would be available on a website portal.
The anticholinergic burden is tested by assigning a score that is based on reported extreme events and aligning closely with the drug's chemical structure in the discussion for a prescription. It results in a the most precise and updated scoring system available today.
Finally, after further advanced research and real-world patient data modeling, the tool could aid in supporting common medicine prescriptions with reduced risk.
Use of medicines with anticholinergic effects can have significant harmful effects for example falls and confusion which are avoidable, we urgently need to reduce the harmful side effects as this can leads to hospitalization and death. This new tool provides a promising avenue towards a more tailored personalized medicine approach, of ensuring the right person gets a safe and effective treatment whilst avoiding unwanted anticholinergic effects.
Chris Fox, Study Author and Professor, University of Exeter
Including prescribing nurses and pharmacists, the team surveyed a total of 110 health professionals. Out of these experts, 85% said they would employ a tool to test the risk of anticholinergic side effects if it was available. To further help in improving the tool, usability feedback was also collected by the team.
Our tool is the first to use innovative artificial intelligence technology in measures of anticholinergic burden—ultimately, once further research has been conducted the tool should support pharmacists and prescribing health professionals in finding the best treatment for patients.
Dr. Saber Sami, University of East Anglia
I have been working in this area for over 20 years. Anti-cholinergic side-effects can be very debilitating for patients. We need better ways to assess these side-effects.
Ian Maidment, Professor, Aston University
The team collaborated with AKFA University Medical School, Uzbekistan, and the Universities of East Anglia, Aston, Kent, and Aberdeen. The researchers aim to continue to improve the tool so that it can be used in everyday practice.
Secchi. A., et al. (2022). A novel Artificial Intelligence-based tool to assess anticholinergic burden: a survey. Age and Ageing. doi.org/10.1093/ageing/afac196.