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

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122 Citations (Scopus)


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DESIGN: electronic published and unpublished literature/trial registries were systematically reviewed.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
Issue number5
Early online date19 Jul 2014
Publication statusPublished - Sep 2014



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

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