the news ...
medications could delay brain injury recovery
Drugs used to treat common complaints could delay the
recovery of brain injury patients.
Prescribed for up to 50 per cent of older people,
medications with anticholinergic properties are used to
treat a broad range of common conditions including
bladder problems, depression and insomnia.
Anticholinergics are already known to have side effects
such as temporary cognitive impairment, dizziness and
confusion. But their effects on people with
pre-existing brain and spinal injuries have not been
investigated until now.
Medications with anti-cholinergic properties are often
used on neuro-rehabilitation units frequently to manage
symptoms from urinary incontinence to pain.
The study of 52 patients with acquired brain or spinal
injury at a neuro-rehabilitation unit 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 ACB.
Results showed that the change in ACB correlated directly
to the length of hospital stay. A higher ACB score on
discharge, compared with on admission, was associated with
a longer stay in hospital and a lower ACB on discharge saw
on average a shorter stay. The team cautioned however that
as an observational study, cause-and-effect relationship
cannot be implied.
Dr Chris Fox, Professor of Clinical Psychiatry at the
Norwich Medical School at UEA and lead author on the
paper, 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
Length of patient stay is used a performance indicator for
hospitals, with financial incentives in place for units to
discharge patients as soon as is safe.
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
Prof Fox said: "Identifying factors which might adversely
affect the length of a patient's stay can have important
financial as well as quality of life implications. So the
findings of this study could be directly useful to current
health care settings if they can reduce the time patients
spend in rehabilitation units, improving wider efficiency
University of East Anglia
(UEA) scientists working with other UK universities
including Aston and the NHS. Brain Injury