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

Fox, Chris, Smith, Toby, Maidment, Ian, Chan, Wei-Yee, Bua, Nelson, Myint, Phyo Kyaw, Boustani, Malaz, Kwok, Chun Shing, Glover, Michelle, Koopmans, Imogen and Campbell, Noll (2014). Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality:a systematic review. Age and Ageing, 43 (5), pp. 604-615.

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the effect of drugs with anti-cholinergic properties on relevant health outcomes.Design: electronic published and unpublished literature/trial registries were systematically reviewed.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. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.

Publication DOI: https://doi.org/10.1093/ageing/afu096
Divisions: Life & Health Sciences
Life & Health Sciences > Pharmacy
Life & Health Sciences > Applied Health Research Group
Additional Information: This is a pre-copyedited, author-produced PDF of an article accepted for publication in Age and Ageing following peer review. The version of record Fox, C., Smith, T., Maidment, I., Chan, W-Y., Bua, N., Myint, P. K., ... Campbell, N. (2014). Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: a systematic review. Age and ageing, 43(5), 604-615 is available online at: http://ageing.oxfordjournals.org/content/43/5/604 Supplementary data: available to subscribers in Age and Ageing online.
Uncontrolled Keywords: adverse effect,anti-cholinergic,anti-muscarinic,cholinergic antagonist,cognition,function,mortality,older people,systematic review,Ageing,Geriatrics and Gerontology
Full Text Link: http://ageing.o ... ontent/43/5/604
Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL)
Published Date: 2014-09-05
Authors: Fox, Chris
Smith, Toby
Maidment, Ian ( 0000-0003-4152-9704)
Chan, Wei-Yee
Bua, Nelson
Myint, Phyo Kyaw
Boustani, Malaz
Kwok, Chun Shing
Glover, Michelle
Koopmans, Imogen
Campbell, Noll

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