Disclosures: Ishita Jain, MD, MEng: No financial relationships or conflicts of interest

Objective: Cognitive impairment is common in individuals with spinal cord injury and disorders (SCID) and may be the result of comorbidities, abnormalities in cardiovascular control, and sleep apnea(1). Anticholinergic drugs are associated with cognitive impairment and dementia(2) and are commonly used in the management of SCI complications. The Anticholinergic Drug Scale (ADS) rates drugs from 0-3 according to anticholinergic activity (ACA)(0 -no known ACA, 3 -marked ACA)(3) . Anticholinergic Burden Score (ACBS) is an estimate of the ACA and is useful to identify those at risk of adverse events(4-7). ACBS above 3 are at higher risk for complications. The goal of this study is to evaluate ACBS in patients with SCID, identify drugs more commonly involved to raise awareness, aide in the decision-making process during prescription, and offer alternatives.

Design: Retrospective chart review. Drugs were compiled at discharge, and ACBS was calculated using ACB calculator (http://www.acbcalc.com/). Analyses were conducted to report descriptive statistics.Setting : Inpatient SCID unit during 2020.Participants : 149 SCID patients (5 female, age 64 ± 12 years-old mean ± SD, 17 Multiple Sclerosis, 1 Amyotrophic Lateral Sclerosis, 131 SCI).

Interventions: None.

Main Outcome Measures: ACBS.

Results: ACBS was 4.9 ± 3.2, 75.8% had ACBS ≥3. A total of 407 drugs with ACA 1-3 were identified, and the most frequent drug groups were antispastic medications (30%), anti-hypertensives (20.6%), anti-depressants (16.7%), bladder antispastic medications (9.3%), anti-histamines (7.4%), anti-psychotics (5.7%), and opioids (4.2%). The average ACBS per group was 3 for bladder anti-spastic drugs, 2.3 for anti-histaminic drugs, and 2.2 for anti-spastic drugs. The most common drugs with ACA of 3 were oxybutynin, trospium, tizanidine, methocarbamol, and diphenhydramine.Conclusions: The majority of SCID patients (75.8%) presented ACBS ≥3, placing them at higher risk for complications associated with anticholinergic use, particularly dementia. Parsimonious prescription of these drugs must be considered and substitutes that have lower ACA should be preferred.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/anticholinergic-burden-score-in-patients-with-spinal-cord-injury-and-disorders/