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The cognitive impact of anticholinergics: a clinical review.

Campbell N, Boustani M, Limbil T, Ott C, Fox C, Maidment I, Schubert CC, Munger S, Fick D, Miller D, Gulati R - Clin Interv Aging (2009)

Bottom Line: Evaluate the existing evidence regarding the effects of anticholinergic medications on cognition in older adults.All but two studies found an association between the anticholinergic activity of medications and either delirium, cognitive impairment or dementia.Recognizing the anticholinergic activity of certain medications may represent a potential tool to improve cognition.

View Article: PubMed Central - PubMed

Affiliation: Wishard Health Services, Indianapolis, IN, USA.

ABSTRACT

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.

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Related in: MedlinePlus

Proposed algorithm for the clinical approach to older adults prescribed anticholinergic medications.Abbreviations: CAM, Confusion Assessment Method; TICS, telephone interview for cognitive status; MMSE, Mini-Mental Status Exam.
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f2-cia-4-225: Proposed algorithm for the clinical approach to older adults prescribed anticholinergic medications.Abbreviations: CAM, Confusion Assessment Method; TICS, telephone interview for cognitive status; MMSE, Mini-Mental Status Exam.

Mentions: We suggest the logical management of anticholinergics use as described in Figure 2. As illustrated in this review, the elderly population, and specifically those experiencing an acute illness, is uniquely sensitive to the central anticholinergic adverse effects of medications and should be closely monitored for the development of unwanted adverse effects on cognition. Recognizing patients at risk due to exposure of anticholinergics should warrant cognitive evaluation not only in acute care environments, but also ambulatory environments when subjective complaints of cognitive impairment supplement clinical suspicion. In clinical practice situations where anticholinergic cognitive adverse effects are suspected, the course of action might be to consider the withdrawal of potentially offending medication(s). Although the expected clinical impact on cognitive deficits with a reduction in anticholinergic burden remains to be sufficiently studied, removal of potentially harmful medications in lieu of equally effective alternatives with lower anticholinergic activity might be a good practice.


The cognitive impact of anticholinergics: a clinical review.

Campbell N, Boustani M, Limbil T, Ott C, Fox C, Maidment I, Schubert CC, Munger S, Fick D, Miller D, Gulati R - Clin Interv Aging (2009)

Proposed algorithm for the clinical approach to older adults prescribed anticholinergic medications.Abbreviations: CAM, Confusion Assessment Method; TICS, telephone interview for cognitive status; MMSE, Mini-Mental Status Exam.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2697587&req=5

f2-cia-4-225: Proposed algorithm for the clinical approach to older adults prescribed anticholinergic medications.Abbreviations: CAM, Confusion Assessment Method; TICS, telephone interview for cognitive status; MMSE, Mini-Mental Status Exam.
Mentions: We suggest the logical management of anticholinergics use as described in Figure 2. As illustrated in this review, the elderly population, and specifically those experiencing an acute illness, is uniquely sensitive to the central anticholinergic adverse effects of medications and should be closely monitored for the development of unwanted adverse effects on cognition. Recognizing patients at risk due to exposure of anticholinergics should warrant cognitive evaluation not only in acute care environments, but also ambulatory environments when subjective complaints of cognitive impairment supplement clinical suspicion. In clinical practice situations where anticholinergic cognitive adverse effects are suspected, the course of action might be to consider the withdrawal of potentially offending medication(s). Although the expected clinical impact on cognitive deficits with a reduction in anticholinergic burden remains to be sufficiently studied, removal of potentially harmful medications in lieu of equally effective alternatives with lower anticholinergic activity might be a good practice.

Bottom Line: Evaluate the existing evidence regarding the effects of anticholinergic medications on cognition in older adults.All but two studies found an association between the anticholinergic activity of medications and either delirium, cognitive impairment or dementia.Recognizing the anticholinergic activity of certain medications may represent a potential tool to improve cognition.

View Article: PubMed Central - PubMed

Affiliation: Wishard Health Services, Indianapolis, IN, USA.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus