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

a systematic review

Chris Fox, Toby Smith, Ian Maidment, Wei-Yee Chan, Nelson Bua, Phyo Kyaw Myint, Malaz Boustani, Chun Shing Kwok, Michelle Glover, Imogen Koopmans, Noll Campbell

Research output: Contribution to journalArticle

110 Citations (Scopus)

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DESIGN: electronic published and unpublished literature/trial registries were systematically reviewed.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.

Original languageEnglish
Pages (from-to)604-615
Number of pages12
JournalAge and Ageing
Volume43
Issue number5
Early online date19 Jul 2014
DOIs
Publication statusPublished - Sep 2014

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Delirium
Cholinergic Antagonists
Cognition
Mortality
Aptitude
Pharmaceutical Preparations
Registries
Health

Keywords

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

Cite this

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; Campbell, Noll.

In: Age and Ageing, Vol. 43, No. 5, 09.2014, p. 604-615.

Research output: Contribution to journalArticle

Fox, C, Smith, T, Maidment, I, Chan, W-Y, Bua, N, Myint, PK, Boustani, M, Kwok, CS, Glover, M, Koopmans, I & Campbell, N 2014, 'Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: a systematic review', Age and Ageing, vol. 43, no. 5, pp. 604-615. https://doi.org/10.1093/ageing/afu096
Fox, Chris ; Smith, Toby ; Maidment, Ian ; Chan, Wei-Yee ; Bua, Nelson ; Myint, Phyo Kyaw ; Boustani, Malaz ; Kwok, Chun Shing ; Glover, Michelle ; Koopmans, Imogen ; Campbell, Noll. / Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality : a systematic review. In: Age and Ageing. 2014 ; Vol. 43, No. 5. pp. 604-615.
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AU - Boustani, Malaz

AU - Kwok, Chun Shing

AU - Glover, Michelle

AU - Koopmans, Imogen

AU - Campbell, Noll

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N2 - 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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