JARS was not associated with discharge ADL, swallowing, or muscle strength, but a modest association with nutritional risk was observed and psychotropic drug-derived JARS was associated with cognitive level, supporting domain- and drug-class-specific interpretation of anticholinergic burden.
The majority of older poststroke rehabilitation patients had measurable anticholinergic burden as assessed by the Japanese Anticholinergic Risk Scale (JARS).
Total JARS was not associated with discharge functional independence in motor activities of daily living.
Higher total JARS was negatively associated with the Geriatric Nutritional Risk Index (GNRI) at discharge in the primary analysis.
Psychotropic drug-derived JARS was independently associated with lower cognitive functional scores at discharge.
Total JARS was not significantly associated with swallowing function or muscle strength at discharge.
The study used the Japanese Anticholinergic Risk Scale (JARS) because international anticholinergic burden scales may incompletely capture country-specific prescribing patterns and drug availability.
This research examined whether the number and type of anticholinergic medications (drugs that block a chemical messenger in the nervous system, commonly used for bladder, stomach, and psychiatric conditions) taken by older Japanese stroke patients during rehabilitation were linked to how well those patients recovered across five different areas: physical function, thinking and memory, swallowing, nutrition, and muscle strength. The study tracked 747 patients with a median age of 80 years, and nearly two-thirds were taking at least one anticholinergic medication on admission to rehabilitation. The main finding was that the overall anticholinergic medication burden, as measured by a Japan-specific scoring tool called JARS, was not clearly linked to recovery in physical function, swallowing, or muscle strength. There was a modest association between higher anticholinergic burden and poorer nutritional status at discharge, but this finding became borderline when the researchers ran additional sensitivity analyses, so it should be treated with caution. Importantly, when the researchers focused only on anticholinergic medications used for psychiatric purposes (such as antipsychotics or certain antidepressants), they found a significant association with worse cognitive scores at discharge. This research suggests that not all anticholinergic medications carry the same risks for older stroke patients, and that the effects may depend on which specific type of medication is being taken and which aspect of health is being measured. In particular, psychotropic (psychiatric) anticholinergic drugs may pose a greater risk for cognitive outcomes. These findings highlight the importance of considering the specific drug class and the particular health domain when evaluating the risks of anticholinergic medications in older patients undergoing stroke rehabilitation.
Matsumoto A, Yoshimura Y. (2026). Japanese Anticholinergic Risk Scale and Domain-Specific Functional Outcomes in Older Poststroke Patients.. Geriatrics & gerontology international. https://doi.org/10.1111/ggi.70842