Anticholinergic burden (prognostic factor) for prediction of dementia or cognitive decline in older adults with no known cognitive syndrome (Review)

Martin Taylor-Rowan, Sophie Edwards, Anna H Noel-Storr, Jenny McCleery, Phyo K Myint, Roy Soiza, Carrie Stewart, Yoon Kong Loke, Terry J Quinn* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Medications with anticholinergic properties are commonly prescribed to older adults. The cumulative anticholinergic eFect of all the medications a person takes is referred to as the 'anticholinergic burden' because of its potential to cause adverse eFects. It is possible that high anticholinergic burden may be a risk factor for development of cognitive decline or dementia. There are various scales available to measure anticholinergic burden but agreement between them is oKen poor.
Objectives
To assess whether anticholinergic burden, as defined at the level of each individual scale, is a prognostic factor for future cognitive decline or dementia in cognitively unimpaired older adults.
Search methods
We searched the following databases from inception to 24 March 2021: MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCOhost), and ISI Web of Science Core Collection (ISI Web of Science).
Selection criteria
We included prospective and retrospective longitudinal cohort and case-control observational studies with a minimum of one year' follow up that examined the association between an anticholinergic burden measurement scale and future cognitive decline or dementia in cognitively unimpaired older adults.
Data collection and analysis
Two review authors independently assessed studies for inclusion, and undertook data extraction, assessment of risk of bias, and GRADE assessment. We extracted odds ratios (OR) andhazard ratios, with 95%confidence intervals (CI), and linear data on the association between anticholinergic burden and cognitive decline or dementia. We intended to pool each metric separately; however, only OR-based data were suitable for pooling via a random-eFects meta-analysis. We initially established adjusted and unadjusted pooled rates for each available
anticholinergic scale; then, as an exploratory analysis, established pooled rates on the prespecified association across scales. We examined variability based on severity of anticholinergic burden
Original languageEnglish
Article numberCD013540
Number of pages71
JournalCochrane Database of Systematic Reviews
Issue number4
DOIs
Publication statusPublished - 5 May 2021

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