AUTHOR=Vidal Nathan , Roux Paul , Urbach Mathieu , Belmonte Cristobal , Boyer Laurent , Capdevielle Delphine , Clauss-Kobayashi Julie , D’Amato Thierry , Dassing Romane , Dubertret Caroline , Dubreucq Julien , Fond Guillaume , Honciuc Roxana-Mihaela , Leignier Sylvain , Llorca Pierre-Michel , Mallet Jasmina , Misdrahi David , Pignon Baptiste , Rey Romain , Schürhoff Franck , Tessier Arnaud , the FACE-SZ (FondaMental Academic Centers of Expertise—Schizophrenia) Group , Passerieux Christine , Brunet-Gouet Eric , Aouizerate B. , Barteau V. , Bensalem S. , Berna F. , Blanc O. , Bourguignon E. , Boyer L. , CapdevielleI. Chéreau D. , Chesnoy-Servanin G. , D’Amato T. , Deloge A. , Denizot H. , Dorey JM. , Dubertret C. , Dubreucq J. , Esselin S. , Faget C. , Fluttaz C. , Fond G. , Gabayet F. , Godin O. , Haffen E. , Honciuc RM. , Jarroir M. , Lacelle D. , Lançon C. , Laouamri H. , Leboyer M. , Llorca PM , Mallet J. , Metairie E. , Misdrahi D. , Passerieux C. , Petrucci J. , Peri P. , Pignon B. , Pires S. , Portalier C. , Rey R. , Roman C. , Schürhoff F. , Souryis K. , Szöke A. , Urbach M. , Vaillant F. , A , Vehier , Vidailhet P. , Vilà E. , Wahiche G. , Yazbek H. , Zinetti-Bertschy A. TITLE=Comparative analysis of anticholinergic burden scales to explain iatrogenic cognitive impairment in schizophrenia: results from the multicenter FACE-SZ cohort JOURNAL=Frontiers in Pharmacology VOLUME=15 YEAR=2024 URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2024.1403093 DOI=10.3389/fphar.2024.1403093 ISSN=1663-9812 ABSTRACT=Aim

The anticholinergic properties of medications are associated with poorer cognitive performance in schizophrenia. Numerous scales have been developed to assess anticholinergic burden and yet, there is no consensus indicating which anticholinergic burden scale is more relevant for patients with schizophrenia. We aimed to identify valid scales for estimating the risk of iatrogenic cognitive impairment in schizophrenia.

Methods

We identified 27 scales in a literature review. The responses to neuropsychological tests of 839 individuals with schizophrenia or schizoaffective disorder in the FACE-SZ database were collected between 2010 and 2021. We estimated the association between objective global cognitive performance and the 27 scales, the number of psychotropic drugs, and chlorpromazine and lorazepam equivalents in bivariable regressions in a cross-sectional design. We then adjusted the bivariable models with covariates: the predictors significantly associated with cognitive performance in multiple linear regressions were considered to have good concurrent validity to assess cognitive performance.

Results

Eight scales, the number of psychotropic drugs, and drug equivalents were significantly associated with cognitive impairment. The number of psychotropic drugs, the most convenient predictor to compute, was associated with worse executive function (Standardized β = −0.12, p = .004) and reasoning (Standardized β = −0.08, p = .037).

Conclusion

Anticholinergic burden, the number of psychotropic drugs, and drug equivalents were weakly associated with cognition, thus suggesting that cognitive impairment in schizophrenia and schizoaffective disorder is explained by factors other than medication. The number of psychotropic drugs was the most parsimonious method to assess the risk of iatrogenic cognitive impairment.