The cognitive impact of anticholinergics: a clinical review.
BACKGROUND
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.


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


METHODS
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.


METHODS
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.
Campbell
Noll
N
Wishard Health Services, Indianapolis, IN, USA.
Boustani
Malaz
M
Limbil
Tony
T
Ott
Carol
C
Fox
Chris
C
Maidment
Ian
I
Schubert
Cathy C
CC
Munger
Stephanie
S
Fick
Donna
D
Miller
David
D
Gulati
Rajesh
R
D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D003072:Cognition Disorders / Q000139:chemically induced*; D003693:Delirium / Q000139:chemically induced; D006801:Humans
D018680:Cholinergic Antagonists