Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: a systematic review

Abstract

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function, but limited evidence exists for delirium or mortality outcomes.

Potentially Inappropriate Anticholinergic Medication Use in Community-Dwelling Older Adults: A National Cross-Sectional Study

“…A systematic review by Fox et al indicated that 77 % of the included studies evaluating cognitive function reported a significant decline in cognitive ability with an increasing anticholinergic burden [16]. A study by Hilmer et al suggested similar findings; increased exposure to medications with anticholinergic and sedative effects, measured through the Drug Burden Index (DBI), was found to be associated with lower physical function over a 5-year period in community-dwelling older adults [17].…”

Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?

“…A recent systematic review of the impact of ACB score on function reported similar inconclusive results between an associated reduction in cognitive function and ACB score within the general population [5]. However, in a subgroup analysis of people with dementia, there appeared to be a strong trend towards an association between reduced cognitive function and increased ACB score [5]. It may be argued that a similar trend is reported in this pilot study, where another group of patients with existing cognitive impairment through acquired brain injury, demonstrate a greater length of stay.…”

“…Their results were inconclusive. A recent systematic review of the impact of ACB score on function reported similar inconclusive results between an associated reduction in cognitive function and ACB score within the general population [5]. However, in a subgroup analysis of people with dementia, there appeared to be a strong trend towards an association between reduced cognitive function and increased ACB score [5].…”

“…These medications have been associated with dizziness, sedation, confusion, delirium, and a decline in physical function, in addition to other side-effects such as dry mouth, dry eyes, constipation, blurred vision and increased heart rate [1,3,4]. A recent systematic review reported that medicines with anti-cholinergic properties in the general population have a significant adverse effect on cognitive and physical function, but limited evidence exists for adverse effects in delirium or on mortality [5]. Consequently, to avoid inappropriate prescribing of anticholinergic drugs, caution has been advised [1].…”

Does Anticholinergic Activity Affect Neuropathology Implication of Neuroinflammation in Alzheimer's Disease

“…There are significant associations reported between high serum anticholinergic activity and cognitive functions and psychiatric symptoms [12,13]. A recent systematic review indicated 77% of included studies evaluating cognitive function (n = 33) reported a significant decline in cognitive ability with increasing anticholinergic load (p < 0.05) [14]. These observations gave rise to the presumption that anticholinergic activity might enhance AD pathologies and neurodegeneration.…”