The 2012 update to the anticholinergic cognitive burden scale

Background: In 2008, the Anticholinergic Cognitive Burden (ACB) scale was generated through a combination of laboratory data, literature review, and expert opinion. This scale identified an increased risk in mortality and worsening cognitive function in multiple populations, including 13,000 older adults in the United Kingdom. We present an updated scale based on new information and new medications available to the market. Methods: We conducted a systematic review for publications recognizing medications with adverse cognitive effects due to anti-cholinergic properties and found no new medications since 2008.Therefore we identified medications from a review of newly ap-proved medications since 2008 and medications identified throughthe clinical experience of the authors. To be included in the updatedACB scale, medications must have met the following criteria; ACBscore of 1: evidence from in vitro data that the medication has antag-onist activity at muscarinic receptors; ACB score of 2: evidence fromliterature, prescriber’s information, or expert opinion of clinical anti-cholinergic effect; ACB score of 3: evidence from literature, pre-scriber’s information, or expert opinion of the medication causingdelirium. Results: The reviewer panel included two geriatric pharmacists,one geriatric psychiatrist, one geriatrician, and one hospitalist.Twenty-three medications were eligible for review and possible inclu-sion in the updated ACB scale. Of these, seven medications were ex-cluded due to a lack of evidence for anticholinergic activity. Of the re-maining 16 medications, ten had laboratory evidence ofanticholinergic activity and added to the ACB list with a score of one.One medication was added with a score of two. Five medicationswere included in the ACB scale with a score of three.Conclusions: The revised ACB scale provides an update of med-ications with anticholinergic effects that may increase the risk of cog-nitive impairment. Future updates will be routinely conducted tomaintain an applicable library of medications for use in clinical andresearch environments.

Adversarial interpreting – a forensic linguistic perspective

Interactions with second language speakers in public service contexts in England are normally conducted with the assistance of one interpreter. Even in situations where team interpreting would be advisable, for example in lengthy courtroom proceedings, financial considerations mean only one interpreter is normally booked. On occasion, however, more than one interpreter, or an individual (or individuals) with knowledge of the languages in question, may be simultaneously present during an interpreted interaction, either monitoring it or indeed volunteering unsolicited input. During police interviews or trials in England this may happen when the interpreter secured by the defence team to interpret during private consultation with the suspect or defendant is present also in the interview room or the courtroom but two independently sourced interpreters need not be limited to legal contexts. In healthcare settings for example, service users sometimes bring friends or relatives along to help them communicate with service providers only to find that the latter have booked an interpreter as a matter of procedure. By analogy to the nature of the English legal system, I refer to contexts where an interpreter’s output is monitored and/or challenged, either during the speech event or subsequently, as ‘adversarial interpreting’. This conceptualisation reflects the fact that interpreters in such encounters are sourced independently, often by opposing parties, and as a result can rarely be considered a team. My main concern in this paper is to throw spotlight on adversarial interpreting as a hitherto rarely discussed problem in its own right. That it is not an anomaly is evidenced by the many cases around the world where the officially recorded interpreted output was challenged, as mentioned in for example Berk-Seligson (2002), Hayes and Hale (2010), and Phelan (2011). This paper reports on the second stage of a research project which has previously involved the analysis of a transcript of an interpreted police interview with a suspect in a murder case. I will mention the findings of the analysis briefly and introduce some new findings based on input from practising interpreters who have shared their experience of adversarial interpreting by completing an online questionnaire. I will try to answer the question of how the presence of two interpreters, or an interpreter and a monitoring participant, in the same speech event impacts on the communication process. I will also address the issue of forensic linguistic arbitration in cases where incompetent interpreting has been identified or an expert opinion is sought in relation to an adversarial interpreting event of significance to a legal dispute. References Berk-Seligson (2002), The Bilingual Courtroom: Court Interpreters in the Judicial Process, University of Chicago Press. Hayes, A. and Hale, S. (2010), "Appeals on incompetent interpreting", Journal of Judicial Administration 20.2, 119-130. Phelan, M. (2011), "Legal Interpreters in the news in Ireland", Translation and Interpreting 3.1, 76-105.