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Cited by 479Pharmaceutical Practices and Patient OutcomesDementia and Cognitive Impairment ResearchIntensive Care Unit Cognitive Disorders

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The cognitive impact of anticholinergics: A clinical review

Open access
Malaz Boustani, Malaz·2009·Clinical Interventions in Aging
DOI 10.2147/cia.s5358PMC PMC2697587
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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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  • Older adults may be more sensitive to anticholinergic effects in the central nervous system because of age-related changes in pharmacokinetics and pharmacodynamics, reduced acetylcholine mediated transmission in the brain, and increased permeability of the blood-brain barrier.

    “Older adults may be more sensitive to anticholinergic effects in the central nervous system because of age-related changes in pharmacokinetics and pharmacodynamics, reduced acetylcholine mediated transmission in the brain, and increased permeability of the blood-brain barrier.7”

    From Cumulative Use of Strong Anticholinergics and Incident Dementia: A Prospective Cohort Study (2015) · cites this paper as [7]

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  1. [2]Wolff JL Prevalence, expenditures, and complications of multiple chronic conditions of the elderly Arch Intern Med 2002 162 2269 2276 12418941
  2. [3]Schubert CC Comorbidity profile of dementia patients in primary care: Are they sicker? JAGS 2006 54 1 104 109 16420205
  3. [4]Boustani M Screening for DementiaSystematic Evidence Review. Rockville, MD Agency for Healthcare Research and Quality 2003 Available from: http://www.ahrq.gov/clinic/uspstfix.htm. 20722116
  4. [5]Tollefson GD The relationship of serum anti-cholinergic activity to mental status performance in an elderly nursing home population J Neuropsychiatry Clin Neurosci 1991 3 3 314 319 1821247
  5. [6]Mulsant BH Serum anticholinergic activity in a community-based sample of older adults Arch Gen Psychiatry 2003 60 198 203 12578438
  6. [7]Blazer DG 2nd The risk of anticholinergic toxicity in the elderly: a study of prescribing practices in two populations J Gerontol 1983 38 31 35 6129272
  7. [8]Wimo A An estimate of the total worldwide societal costs of dementia in 2005 Alzheimer and Dementia 2007 3 81 921 19595921
  8. [9]Tune LE Anticholinergic effects of medications in elderly patients J Clin Psychiatry 2001 62 21 11 14 11584981
  9. [10]Tune LE Association of postoperative delirium with raised serum levels of anti-cholinergic drugs Lancet 1981 2 8248 651 653 6116042
  10. [11]Miller PS Association of low serum anticholinergic levels and cognitive impairment in elderly presurgical patients Am J Psychiatry 1988 145 342 345 3344848
  11. [12]Ancelin ML Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study BMJ 2006 332 7539 455 459 16452102 PMC1382539
  12. [13]Bottigi KA Long-term cognitive impact of anticholinergic medications in older adults Am J Geriatr Psychiatry 2006 14 11 980 984 17068321
  13. [14]Caeiro L Delirium in acute stroke: a preliminary study of the role of anticholinergic medications Eur J Neurol 2004 11 699 704 15469455
  14. [15]Chew ML Serum anticholinergic activity and cognition in patients with moderate-to-severe dementia Am J Geriatr Psychiatry 2005 13 5354 538 15956274
  15. [16]Flacker JM The association of serum anticholinergic activity with delirium in elderly medical patients Am J Geriatr Psychiatry 1998 6 31 41 9469212
  16. [17]Flacker JM Serum anticholinergic activity changes with acute illness in elderly medical patients J Gerontol A Biol Sci Med Sci 1999 54 1 M12 M16 10026657
  17. [18]Golinger RC Association of elevated plasma anticholinergic activity with delirium in surgical patients Am J Psychiatry 1987 144 9 1218 1220 3631323
  18. [19]Han L Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients Arch Intern Med 2006 161 1099 1105 11322844
  19. [20]Hilmer SN A Drug Burden Index to define the functional burden of medications in older people Arch Intern Med 2007 167 781 787 17452540
  20. [21]Lechevallier-Michel N Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID study Br J Clin Pharmacol 2004 59 2 143 151 PMC1884748 15676035
  21. [22]Lu CJ Chronic exposure to anticholinergic medications adversely affects the course of Alzheimer disease Am J Geriatr Psychiatry 2003 11 4 458 461 12837675
  22. [23]Mach JR Jr Serum anticholinergic activity in hospitalized older persons with delirium: a preliminary study J Am Geriatr Soc 1995 43 5 491 495 7730529
  23. [24]Marcantonio ER The relationship of postoperative delirium with psychoactive medications JAMA 1994 272 19 1518 1522 7966844
  24. [25]Miller PS Association of low serum anticholinergic levels and cognitive impairment in elderly presurgical patients Am J Psychiatry 1988 145 3 342 345 3344848
  25. [26]Minzenberg MJ Association of anticholinergic load with impairment of complex attention and memory in schizophrenia Am J Psychiatry 2004 161 116 124 14702259
  26. [27]Mondimore FM Post-ECT confusional states associated with elevated serum anticholinergic levels Am J Psychiatry 1983 140 7 930 931 6859321
  27. [28]Mussi C Importance of serum anticholinergic activity in the assessment of elderly patients with delirium J Geriatr Psychiatry Neurol 1999 12 2 82 86 10483930
  28. [29]Nebes RD Low-level serum anticholinergicity as a source of baseline cognitive heterogeneity in geriatric depressed patients Psychopharmacol Bull 1997 33 4 715 720 9493484
  29. [30]Nebes RD Serum anticholinergic activity, white matter hyperintensities, and cognitive performance Neurology 2005 65 1487 1489 16275844
  30. [31]Patten SB Delirium in psychiatric inpatients: a case-control study Can J Psychiatry 2001 46 162 166 11280086
  31. [32]Plaschke K EEG changes and serum anti-cholinergic activity measured in patients with delirium in the intensive care unit Anaesthesia 2007 62 1217 1223 17991256
  32. [33]Roe CM Use of anticholinergic medications by older adults with dementia JAGS 2002 50 836 842 12028169
  33. [34]Rovner BW Self-care capacity and anticholinergic drug levels in nursing home patients Am J Psychiatry 1988 145 1 107 109 3337276
  34. [35]Thienhaus OJ Anticholinergic serum levels and cognitive performance Eur Arch Psychiatry Clin Neurosci 1990 240 1 28 33 2147899
  35. [36]Inouye SK Clarifying confusion: the confusion assessment method. A new method for detection of delirium Ann Intern Med 1990 113 941 948 2240918
  36. [37]Albert MS The Delirium Symptom Interview: an interview for the detection of delirium symptoms in hospitalized patients J Geriatr Psychiatry Neurol 1992 5 14 21 1571069
  37. [38]Folstein MF “Mini-Mental State:” A practical method for grading the cognitive state of patients for the clinician J Psychiatry Res 1975 12 189 198 1202204
  38. [40]Dyer CB Postoperative delirium: a review of 80 primary data-collection studies Arch Intern Med 1995 155 5 461 465 7864702
  39. [41]Carnahan RM The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: Association with Serum Anticholinergic Activity J Clin Pharmacol 2006 46 1481 1486 17101747
  40. [42]Trzepacz PT The neuropathogenesis of delirium Psychosomatics 1994 4 374 391 7916159
  41. [43]Thomas C Serum anticholinergic activity and cerebral cholinergic dysfunction: An EEG study in frail elderly with and without delirium BMC Neuroscience 2008 9 86 1 10 18793418 PMC2564970
  42. [44]Dixon CE Traumatic brain injury reduces hippocampal high-affinity [3H]choline uptake but not extracellular choline levels in rats Neurosci Lett 1994 180 127 130 7700564
  43. [45]Dixon CE Increased anticholinergic sensitivity following closed skull impact and controlled cortical impact traumatic brain injury in the rat J Neurotrauma 1994 11 275 287 7996582
  44. [46]Boustani M The association between cognition and histamine-2 receptor antagonists in African Americans J Am Geriatr Soc 2007 55 8 1248 1253 17661965 PMC2860609

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Metadata

Authors
Malaz Boustani, M.
Venue
Clinical Interventions in Aging
Publisher
Informa UK Limited
Published
2009-05
Volume
4
Pages
225
ISSN
  • 1176-9092 (ISSN-L)
  • 1178-1998
DOI
10.2147/cia.s5358
PMC
PMC2697587
OpenAlex
W2107996856
Cited by
479
References
0
Citations by year
2026: 9 · 2025: 15 · 2024: 23 · 2023: 23 · 2022: 27 · 2021: 29 · 2020: 48 · 2019: 43 · 2018: 33 · 2017: 31 · 2016: 39 · 2015: 40 · 2014: 27 · 2013: 32 · 2012: 29
FWCI
2.30
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Interventions in Aging (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Aston Publications Explorer (Aston University) (acceptedVersion)
  • Aston Publications Explorer (Aston University) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
  • IUScholarWorks (Indiana University) (submittedVersion, cc-by)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
Funders
  • John A. Hartford Foundation
  • Hartford Foundation for Public Giving
  • Atlantic Philanthropies
  • Starr Foundation
  • National Institute on Aging (K23 AG 26770-01, K23AG026770)
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
Keywords
anticholinergic agents, cognitive impairment, older adults, delirium, dementia, adverse drug reactions, polypharmacy, cognitive performance
MeSH terms
Cognition Disorders, Delirium, Humans, Cholinergic Antagonists

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