Chris Fox1, Toby Smith2, Ian Maidment3, Wei-Yee Chan1, Nelson Bua1, Phyo Kyaw Myint4, Malaz Boustani5, Chun Shing Kwok6, Michelle Glover1, Imogen Koopmans1, Noll Campbell7. 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 DESIGN: electronic published and unpublished literature/trial registries were systematically reviewed.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.
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 DESIGN: electronic published and unpublished literature/trial registries were systematically reviewed.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.
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