Anti-cholinergic load, health care utilization, and survival in people with advanced cancer: a pilot study.

INTRODUCTION: Anti-cholinergic medications have been associated with increased risks of cognitive impairment, premature mortality and increased risk of hospitalisation. Anti-cholinergic load associated with medication increases as death approaches in those with advanced cancer, yet little is known about associated adverse outcomes in this setting. METHODS: A substudy of 112 participants in a randomised control trial who had cancer and an Australia modified Karnofsky Performance Scale (AKPS) score (AKPS) of 60 or above, explored survival and health service utilisation; with anti-cholinergic load calculated using the Clinician Rated Anti-cholinergic Scale (modified version) longitudinally to death. A standardised starting point for prospectively calculating survival was an AKPS of 60 or above. RESULTS: Baseline entry to the sub-study was a mean 62 +/- 81 days (median 37, range 1-588) days before death (survival), with mean of 4.8 (median 3, SD 4.18, range 1 - 24) study assessments in this time period. Participants spent 22% of time as an inpatient. There was no significant association between anti-cholinergic score and time spent as an inpatient (adjusted for survival time) (p = 0.94); or survival time. DISCUSSION: No association between anti-cholinergic load and survival or time spent as an inpatient was seen. Future studies need to include cognitively impaired populations where the risks of symptomatic deterioration may be more substantial.

Visual imagery in autobiographical memory: The role of repeated retrieval in shifting perspective.

Recent memories are generally recalled from a first-person perspective whereas older memories are often recalled from a third-person perspective. We investigated how repeated retrieval affects the availability of visual information, and whether it could explain the observed shift in perspective with time. In Experiment 1, participants performed mini-events and nominated memories of recent autobiographical events in response to cue words. Next, they described their memory for each event and rated its phenomenological characteristics. Over the following three weeks, they repeatedly retrieved half of the mini-event and cue-word memories. No instructions were given about how to retrieve the memories. In Experiment 2, participants were asked to adopt either a first- or third-person perspective during retrieval. One month later, participants retrieved all of the memories and again provided phenomenology ratings. When first-person visual details from the event were repeatedly retrieved, this information was retained better and the shift in perspective was slowed.