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 journalReview article

132 Scopus citations

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the effect of drugs with anti-cholinergic properties on relevant health outcomes.Design: electronic published and unpublished literature/trial registries were systematically reviewed.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 (US)
Article numberafu096
Pages (from-to)604-615
Number of pages12
JournalAge and Ageing
Volume43
Issue number5
DOIs
StatePublished - Sep 2014

Keywords

  • Adverse effect
  • Anti-cholinergic
  • Anti-muscarinic
  • Cholinergic antagonist
  • Cognition
  • Function
  • Mortality
  • Older people
  • Systematic review

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology

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    Fox, C., Smith, T., Maidment, I., Chan, W. Y., Bua, N., Myint, P. K., Boustani, M., Kwok, C. S., 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, 43(5), 604-615. [afu096]. https://doi.org/10.1093/ageing/afu096