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The cognitive impact of anticholinergics: A clinical review

Authors Campbell N, Malaz Boustani M, Limbil T, Ott C, Fox C, Maidment I, Schubert CC, Munger S, Fick D, Miller D, Gulati R

Published 13 May 2009 Volume 2009:4 Pages 225—233


Review by Single-blind

Peer reviewer comments 5

Noll Campbell4, Malaz Boustani1,2,3, Tony Limbil1, Carol Ott4,5, Chris Fox6,7,8, Ian Maidment6,7, Cathy C Schubert3, Stephanie Munger1,2, Donna Fick9,10, David Miller3, Rajesh Gulati11

1Regenstrief Institute, Inc. Indianapolis, IN, USA; 2Indiana University Center for Aging Research; 3Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; 4Wishard Health Services, Indianapolis, IN, USA; 5School of Pharmacy and Pharmaceutical Sciences, Purdue University, West Lafayette, IN, USA; 6Kent Institute of Medicine and Health Sciences, University of Kent, Canterbury, Kent, UK; 7Kent and Medway NHS Trust, Dartford, Kent, UK; 8Postgraduate Medical Institute, University of Hull, Hull, UK; 9Penn State University School of Nursing; 10Department of Psychiatry, Penn State College of Medicine; 11Indiana University Medical Group – Primary Care, Indianapolis, IN, USA

Context: The cognitive side effects of medications with anticholinergic activity have been documented among older adults in a variety of clinical settings. However, there has been no systematic confirmation that acute or chronic prescribing of such medications lead to transient or permanent adverse cognitive outcomes.

Objective: Evaluate the existing evidence regarding the effects of anticholinergic medications on cognition in older adults.

Data sources: We searched the MEDLINE, OVID, and CINAHL databases from January, 1966 to January, 2008 for eligible studies.

Study selection: Studies were included if the anticholinergic activity was systematically measured and correlated with standard measurements of cognitive performance. Studies were excluded if they reported case studies, case series, editorials, and review articles.

Data extraction: We extracted the method used to determine anticholinergic activity of medications and its association with cognitive outcomes.

Results: Twenty-seven studies met our inclusion criteria. Serum anticholinergic assay was the main method used to determine anticholinergic activity. All but two studies found an association between the anticholinergic activity of medications and either delirium, cognitive impairment or dementia.

Conclusions: Medications with anticholinergic activity negatively affect the cognitive performance of older adults. Recognizing the anticholinergic activity of certain medications may represent a potential tool to improve cognition.

Keywords: anticholinergic activity, cognitive impairment, delirium, elderly

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