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

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Abstract

to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes.

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Most cited references 41

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Incidence and preventability of adverse drug events among older persons in the ambulatory setting.

Jerry Gurwitz (2003)

Adverse drug events, especially those that may be preventable, are among the most serious concerns about medication use in older persons cared for in the ambulatory clinical setting. To assess the incidence and preventability of adverse drug events among older persons in the ambulatory clinical setting. Cohort study of all Medicare enrollees (30 397 person-years of observation) cared for by a multispecialty group practice during a 12-month study period (July 1, 1999, through June 30, 2000), in which possible drug-related incidents occurring in the ambulatory clinical setting were detected using multiple methods, including reports from health care providers; review of hospital discharge summaries; review of emergency department notes; computer-generated signals; automated free-text review of electronic clinic notes; and review of administrative incident reports concerning medication errors. Number of adverse drug events, severity of the events (classified as significant, serious, life-threatening, or fatal), and whether the events were preventable. There were 1523 identified adverse drug events, of which 27.6% (421) were considered preventable. The overall rate of adverse drug events was 50.1 per 1000 person-years, with a rate of 13.8 preventable adverse drug events per 1000 person-years. Of the adverse drug events, 578 (38.0%) were categorized as serious, life-threatening, or fatal; 244 (42.2%) of these more severe events were deemed preventable compared with 177 (18.7%) of the 945 significant adverse drug events. Errors associated with preventable adverse drug events occurred most often at the stages of prescribing (n = 246, 58.4%) and monitoring (n = 256, 60.8%), and errors involving patient adherence (n = 89, 21.1%) also were common. Cardiovascular medications (24.5%), followed by diuretics (22.1%), nonopioid analgesics (15.4%), hypoglycemics (10.9%), and anticoagulants (10.2%) were the most common medication categories associated with preventable adverse drug events. Electrolyte/renal (26.6%), gastrointestinal tract (21.1%), hemorrhagic (15.9%), metabolic/endocrine (13.8%), and neuropsychiatric (8.6%) events were the most common types of preventable adverse drug events. Adverse drug events are common and often preventable among older persons in the ambulatory clinical setting. More serious adverse drug events are more likely to be preventable. Prevention strategies should target the prescribing and monitoring stages of pharmaceutical care. Interventions focused on improving patient adherence with prescribed regimens and monitoring of prescribed medications also may be beneficial.

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Lorazepam Is an Independent Risk Factor for Transitioning to Delirium in Intensive Care Unit Patients

Grant Wilkinson, Pratik Pandharipande, Ayumi Shintani … (2006)

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Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study.

Marie-Laure Ancelin, Olivier Rouaud, Karen Ritchie … (2009)

Despite the high intake of medications with anticholinergic properties by community-dwelling elderly persons, the effects on cognitive decline and dementia have rarely been evaluated. Participants were 4128 women and 2784 men 65 years or older from a population-based cohort recruited from 3 French cities. Cognitive performance, clinical diagnosis of dementia, and anticholinergic use were evaluated at baseline and 2 and 4 years later. A total of 7.5% of the participants reported anticholinergic drug use at baseline. Multivariate-adjusted logistic regression indicated that women reporting use of anticholinergic drugs at baseline showed greater decline over 4 years in verbal fluency scores (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.11-1.79) and in global cognitive functioning (OR, 1.22; 95% CI, 0.96-1.55) than women not using anticholinergic drugs. In men, an association was found with decline in visual memory (OR, 1.63; 95% CI, 1.08-2.47) and to a lesser extent in executive function (OR, 1.47; 95% CI, 0.89-2.44). Notable interactions were observed in women between anticholinergic use and age, apolipoprotein E, or hormone therapy. A 1.4- to 2-fold higher risk of cognitive decline was observed for those who continuously used anticholinergic drugs but not for those who had discontinued use. The risk of incident dementia over the 4-year follow-up period was also increased in continuous users (hazard ratio [HR], 1.65; 95% CI, 1.00-2.73) but not in those who discontinued the use of anticholinergic drugs (HR, 1.28; 95% CI, 0.59-2.76). Elderly people taking anticholinergic drugs were at increased risk for cognitive decline and dementia. Discontinuing anticholinergic treatment was associated with a decreased risk. Physicians should carefully consider prescription of anticholinergic drugs in elderly people, especially in the very elderly and in persons at high genetic risk for cognitive disorder.

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Author and article information

Journal

Journal ID (iso-abbrev): Age Ageing

Title: Age and ageing

ISSN (Electronic): 1468-2834

ISSN (Print): 0002-0729

Publication date (Electronic): Sep 2014

Volume: 43

Issue: 5

Affiliations

[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.

Article

Publisher Item ID: afu096

DOI: 10.1093/ageing/afu096

PubMed ID: 25038833

SO-VID: c1173eb7-5bf7-42c3-8a51-a6a3cfcfa49e

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Keywords: adverse effect,anti-cholinergic,anti-muscarinic,cholinergic antagonist,cognition,function,mortality,older people,systematic review

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Keywords: adverse effect, anti-cholinergic, anti-muscarinic, cholinergic antagonist, cognition, function, mortality, older people, systematic review

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

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Most cited references 41

Incidence and preventability of adverse drug events among older persons in the ambulatory setting.

Lorazepam Is an Independent Risk Factor for Transitioning to Delirium in Intensive Care Unit Patients

Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study.

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