This study is currently not recruiting participants.

Reducing Risk of Dementia through Deprescribing: Cognitive Outcomes After AntiCholinergic Reduction (R2D2: COACH)

Evaluating a Program to Reduce Anticholinergic Medication Prescribing

Not Recruiting
65 years - 100 years
All

Brief description of study.

This study will evaluate the effects of the use of a program to reduce prescribing of a group of commonly prescribed medications called anticholingerics that may adversely effect cognitive functioning in older adults.

Eligibility of study

You may be eligible for this study if you meet the following criteria:

  • Conditions: Dementia
  • Age: 65 years - 100 years
  • Gender: All

Inclusion Criteria

At least one office visit to their primary care physician within the previous 12 months;
At least one order for a strong anticholinergic medication in the previous 12 months
 Subjective cognitive dysfunction by meeting either (a) or (b) of the following criteria:
a.    A response of “somewhat worse” or “much worse” to the SCD screening question: “In general, how would you describe your memory as compared to 10 years ago? Response offerings are: much better / somewhat better / about the same / somewhat worse / much worse.
b.    A score of 5 or less on the Six-Item Screener (SIS).98 The SIS is a global measure of cognitive status that assesses three-item recall and orientation to year, month, and day of the week.
Able to communicate in English;
Access to a telephone

Exclusion Criteria

Permanent resident of an extended care facility (nursing home)
Diagnosis of schizophrenia, bipolar disorder, or schizoaffective disorder defined by ICD9/10 codes
Diagnosis of ADRD as determined by either:
a.     ICD-9/ICD10 codes, or
b.    Current use of a medication for ADRD, or
c.    SIS score less than 3
d.    Functional Activities Questionnaire (FAQ) score greater than 7 indicating ADRD Used by itself, the FAQ has a sensitivity of 0.85 and specificity of 0.81 for the diagnosis of ADRD. When used in conjunction with a cognitive screening tool, such as the SIS, specificity improves to 0.89 with sensitivity of 0.91 for the diagnosis of ADRD.

This study investigates the effects of a program aimed at reducing the prescribing of anticholinergic medications, which are commonly used drugs that can negatively affect memory and thinking in older adults. Anticholinergic medications block a neurotransmitter called acetylcholine, which is important for brain functions like memory and learning. The study will focus on older adults who have been prescribed these medications to see if reducing their use can improve cognitive health.

Participants in the study will be evaluated to determine their cognitive function and medication use. The study will involve assessments using tools like the Six-Item Screener, which checks memory and orientation, and the Functional Activities Questionnaire, which measures daily living skills. Participants will be monitored to see how changes in their medication use affect their cognitive status.

  • Who can participate: Participants must have visited their primary care doctor at least once in the past year and have been prescribed a strong anticholinergic medication in that time. They should also report some decline in memory or score low on a cognitive status test. Participants need to speak English and have access to a telephone.
  • Study details: Participants will undergo evaluations of their memory and cognitive function. They will be asked about their medication use and may receive instructions to adjust their medication.
Updated on 19 Feb 2024. Study ID: 1706800075

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