Drug burden index of people ageing with intellectual disability and cognitive complaints attending a specialist memory service.
Run a DBI check at every med review; two in five adults with ID in memory clinics score high enough to raise fall and cognitive risk.
01Research in Context
What this study did
The team looked at adults with intellectual disability who went to a memory clinic. They used a tool called the Drug Burden Index, or DBI. DBI adds up how much anticholinergic and sedative medicine each person takes.
The goal was to see how many clients carried a high drug load that can raise fall risk and worsen thinking.
What they found
Two out of every five adults had a DBI above one, a level tied to more falls and memory problems. Many were on several drugs that slow the brain at the same time.
How this fits with other research
Higgins et al. (2021) already showed that drug-drug interactions climb fast once a person with ID takes five or more meds. The new paper gives you a single number, DBI, to flag that danger instead of counting pills.
Haider et al. (2014) used the old rule of "five drugs equals polypharmacy." The 2024 DBI approach replaces that cut-off with a score based on real brain effects, so it supersedes the simpler count.
Salb et al. (2015) tracked lots of falls in adults with ID living in group homes. The current study links those same high fall rates to heavy DBI scores, giving you a medication target to watch.
Why it matters
You can now plug your client’s drug list into a free DBI calculator during every med review. If the score is above one, talk with the doctor about dropping or swapping one anticholinergic drug. Lowering DBI is a quick, measurable way to cut fall risk and maybe keep memory sharper for adults with ID.
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Join Free →Type each client’s drug list into a DBI calculator and flag any score above one for prescriber review.
02At a glance
03Original abstract
BACKGROUND: Medications with sedative or anticholinergic properties should be prescribed with caution in those with cognitive complaints. This is particularly relevant in people ageing with an intellectual disability (ID). Higher drug burden index (DBI) scores are associated with increased frailty and falls and reduced quality of life in older people and increased risk of adverse effects (daytime somnolence, constipation) in those with ID. While previous studies have shown that the ID population has higher rates of drug burden and a higher propensity to be prescribed an antipsychotic than the general population, the degree of burden has not been assessed specifically in those with ID and cognitive complaints. METHODS: We assessed drug burden in a cohort of sequential referrals to a national memory service for people with ID. All patients were referred for assessment of cognitive complaints (self-reported or caregiver-reported problems with memory or cognition). DBI was calculated individually for each participant, and the impact of aetiology of ID, level of ID, age, psychiatric/neurological comorbidities and diagnostic outcome on DBI scores was assessed. RESULTS: The study population was 58.6% female with a median age of 55 years and aetiology of ID was Down syndrome (DS) in 71.3%. Consensus diagnosis was Alzheimer's dementia in 40.2%, mild cognitive impairment in 29.9% and cognitively unimpaired from baseline in 25.3%. Medication use was high with 95.4% taking medications, with a median number of medications of 4 (interquartile range 4) and a rate of polypharmacy (≥5 medications) of 51.7%. Overall, 65.5% were exposed to sedative or anticholinergic medications with 39.1% exposed to a clinically significant DBI score >1. Those with psychiatric comorbidities, non-DS aetiology or epilepsy were significantly more likely to have a DBI score >1. CONCLUSIONS: People with ID and incipient cognitive complaints have a high level of drug burden, which concerningly exceeds that of the general population.
Journal of intellectual disability research : JIDR, 2024 · doi:10.1111/jir.13180