AI-based Tool May Help Minimize Side Effects of Anticholinergic Medicines

Blocking acetylcholine increases risks of confusion, dizziness, falls, blurred vision

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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A new online tool based on artificial intelligence could help reduce possible side effects from anticholinergic medications, a class of therapies often used to control Parkinson’s disease symptoms.

“This new tool provides a promising avenue towards a more tailored personalised medicine approach, of ensuring the right person gets a safe and effective treatment whilst avoiding unwanted anticholinergic effects,” Chris Fox, a professor at the University of Exeter, said in a press release.

Anticholinergic medications work by blocking the activity of acetylcholine, an important chemical messenger (neurotransmitter) nerve cells use to communicate with each other. In addition to controlling Parkinson’s symptoms, some anticholinergic medications may be used to help manage depression, bladder, or stomach issues. Other medications also can have secondary anticholinergic effects.

While these medicines can be helpful for controlling symptoms, blocking acetylcholine can cause anticholinergic side effects such as confusion, blurred vision, dizziness, and an increased risk of falls.

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Researchers in the U.K. developed the International Anticholinergic Cognitive Burden Tool (IACT) to help assess the potential anticholinergic side effect burden associated with various medicines. IACT uses artificial intelligence to sort through reports of events in the scientific literature, as well as chemical analyses of the medicine’s structure to help identify side effect risk.

“Our tool is the first to use innovative artificial intelligence technology in measures of anticholinergic burden,” Saber Sami, PhD, from the University of East Anglia, said.

After developing their tool, the researchers surveyed healthcare professionals to better understand how they viewed it. They published their results in Age and Ageing, in the study, “A novel Artificial Intelligence-based tool to assess anticholinergic burden: a survey.”

The survey was answered by 110 healthcare professionals — most being medical doctors (47.3%) or pharmacists (38.2%), with the remainder including nurses, physician associates, and scientists. About three-quarters of the respondents were familiar with national guidelines about anticholinergics and most agreed that prescribers should assess the potential anticholinergic burden when determining which medicines to give patients.

Just over half (54.13%) said they assess anticholinergic burden using standardized tools, most commonly the ACB scale, a measure based on reviews of the scientific literature, which assigns a set burden score to commonly prescribed therapies.

“[T]he results show an understanding of the importance of calculating AchB [anticholinergic burden] and interest in using a tool to calculate AchB in the routine clinical practice. However, the use of the tools was perceived as time consuming and more than one-third of the participants admitted not using them, indicating that more work should be done to simplify their use,” the researchers wrote.

Respondents who commonly measured anticholinergic burden in practice were asked to compare the IACT against the ACB scale or other tools currently used in practice.

Of 34 responses, 20.59% rated it better and 8.82% a lot better, while 44.12% rated it as neither better nor worse. Among the remainder, 14.71% rated IACT as worse and 11.76% somewhat worse.

Respondents noted the tool is somewhat time-consuming to use and that it may be improved by offering suggestions for alternative medicines, including dosage information and adding more information to take into account patients’ co-occurring health conditions, or comorbidities. The researchers continue to explore ways to refine and improve the tool.

“The IACT, once refined, will help practitioners to standardise prescribing practice, it will help to improve medication monitoring and most importantly it will help to improve patients’ health by preventing anticholinergic side-effects,” the researchers wrote.

“Use of medicines with anticholinergic effects can have significant harmful effects for example falls and confusion which are avoidable,” Fox, a co-author of the study said, noting reducing harmful side effects is urgently needed because they can lead to hospitalizations and death.

Sami, also a study co-author, said the “tool should support pharmacists and prescribing health professionals in finding the best treatment for patients” once more research has been done.

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