Assessing the Anticholinergic Cognitive Burden Classification of
Putative Anticholinergic Drugs Using ADME Properties
Abstract
Aim: This study evaluated the use of machine learning in leveraging drug
ADME data to develop a novel anticholinergic burden (AB) scale and
compared its performance to previously published scales. Methods:
Experimental and in silico ADME data were collected for antimuscarinic
activity, blood-brain barrier penetration, bioavailability, chemical
structure and P-gp substrate profile. These five ADME properties were
used to train an unsupervised model to assign anticholinergic burden
scores to drugs. The performance of the model was evaluated through
10-fold cross-validation and compared with the clinical ACB scale and
non-clinical ATS scale which is based primarily on muscarinic binding
affinity. Results: In silico software (ADMET predictor ®) used for
screening drugs for their blood-brain barrier (BBB) penetration
correctly identified some drugs that do not cross the BBB. The mean AUC
for the unsupervised and ACB scale based on five selected features was
0.76 and 0.64 respectively. The unsupervised model agreed with the ACB
scale on the classification of more than half of the drugs (n=49 of
m=88) and agreed on the classification of less than half the drugs in
the ATS scale (n=12/25). Conclusion: Our findings suggest that the
commonly used ACB scale may misclassify certain drugs due to their
inability to cross the BBB. On the other hand, the ATS scale would
misclassify drugs solely depending on muscarinic binding affinity
without considering ADME properties. Machine learning models can be
trained on these features to build classification models that are easy
to update and have greater generalizability.