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Age Ageing. 2014 Sep;43(5):604-15. doi: 10.1093/ageing/afu096. Epub 2014 Jul 19.

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

Author information

1
School of Medicine, University of East Anglia, Norwich, Norfolk NR47TJ, UK.
2
School of Rehabilitation Sciences, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK.
3
Pharmacy, School of Life and Health Sciences, Medicines and Devices in Ageing, Aston Research Centre for Healthy Ageing, (ARCHA), Aston University, Birmingham, UK.
4
School of Medicine & Dentistry, University of Aberdeen, Aberdeen, Scotland AB25 2ZD, UK.
5
Indiana University School of Medicine, Indianapolis, IN, USA.
6
Norfolk and Norwich University Hospital, Norwich, Norfolk NR4 7UY, UK.
7
Purdue University, IN, USA.

Abstract

OBJECTIVES:

to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes.

DESIGN:

electronic published and unpublished literature/trial registries were systematically reviewed. Studies evaluating medications with anti-cholinergic activity on cognitive function, delirium, physical function or mortality were eligible.

RESULTS:

forty-six studies including 60,944 participants were included. Seventy-seven percent of included studies evaluating cognitive function (n = 33) reported a significant decline in cognitive ability with increasing anti-cholinergic load (P < 0.05). Four of five included studies reported no association with delirium and increasing anti-cholinergic drug load (P > 0.05). Five of the eight included studies reported a decline in physical function in users of anti-cholinergics (P < 0.05). Three of nine studies evaluating mortality reported that the use of drugs with anti-cholinergic properties was associated with a trend towards increased mortality, but this was not statistically significant. The methodological quality of the evidence-base ranged from poor to very good.

CONCLUSION:

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

KEYWORDS:

adverse effect; anti-cholinergic; anti-muscarinic; cholinergic antagonist; cognition; function; mortality; older people; systematic review

PMID:
25038833
DOI:
10.1093/ageing/afu096
[Indexed for MEDLINE]

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