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Anticholinergics could delay brain injury recovery

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Nurses should regularly review medication in brain injury patients to ensure those with anticholinergic effects are used appropriately, according to UK researchers.

Their research has suggested anticholinergic drugs, used to treat a broad range of common complaints such as bladder problems, depression and insomnia, could delay the recovery of patients with brain injuries.

“Regular medication review by a nurse, doctor or pharmacist may be a way of ensuring that medicines with anti-cholinergic effects are used appropriately”

Ian Maidment

Medications with anticholinergic properties are prescribed to up to 50% of older people, noted the researchers in the journal Brain Injury.

They are also often used in neuro-rehabilitation units to manage symptoms, from urinary incontinence to pain, in those with pre-existing brain and spinal injuries.

The new study involved 52 patients with acquired brain or spinal injury being treated at a neuro-rehabilitation unit.

It showed that the average length of stay was longer in patients with a higher level of anticholinergic drugs in their system, known as the “anticholinergic drug burden” or ABC.

The change in the burden correlated directly to the length of hospital stay, said the study authors, some of whom were based at East Kent Hospitals University NHS Foundation Trust and Norfolk and Norwich University Hospitals NHS Foundation Trust.

A higher ABC score on discharge, compared with on admission, was associated with a longer stay in hospital and a lower ABC on discharge saw on average a shorter stay.

However, the researchers cautioned that their study was observational and, therefore, cause-and-effect relationship could not be implied.

“The findings of this study could be directly useful to current healthcare settings if they can reduce the time patients spend in rehabilitation units, improving wider efficiency of care”

Chris Fox

Lead study author Dr Chris Fox, from the University of East Anglia, said: “The findings suggest there may be a statistically significant relationship between ACB score and length of stay in a neuro-rehabilitation unit following traumatic brain or spinal cord injury.”

He added: “This pilot study demonstrates the need for larger studies to confirm the results and need for further investigation into what long-term effects these common medications are having on the recovery of these patients.”

“While medications with ACB are often needed to treat common complications of brain or spinal cord injuries, cognitive impairment due to the medication may adversely affect a patient’s ability to engage in the rehabilitation process, potentially increasing their length of stay in hospital,” he said.

Co-author Dr Ian Maidment, senior lecturer in clinical pharmacy at Aston University, said: “This work adds to the evidence that anticholinergics should be avoided in a wide-range of populations, when possible.

“Regular medication review by a nurse, doctor or pharmacist may be a way of ensuring that medicines with anti-cholinergic effects are used appropriately,” he added.

The study follows recent research – also by the University of East Anglia – that found serious falls were more than twice as likely in older men who take medicines with anticholinergic properties.

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