title: Association between prescribing of anticholinergic medications and incident delirium: a cohort study.
abstract: OBJECTIVE
  To describe the association between anticholinergic medications and incident delirium in hospitalized older adults with cognitive impairment and to test the hypothesis that anticholinergic medications would increase the risk of incident delirium.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Urban public hospital in Indianapolis, Indiana.
  
  
  METHODS
  One hundred forty-seven participants aged 65 and older with cognitive impairment who screened negative for delirium at the time of admission to a general medical ward.
  
  
  METHODS
  Cognitive function at the time of admission was assessed using the Short Portable Mental Status Questionnaire (SPMSQ). Anticholinergic medication orders between the time of admission and the final delirium assessment were evaluated. Anticholinergic medication orders were identified using the Anticholinergic Cognitive Burden Scale. Delirium was assessed using the Confusion Assessment Method.
  
  
  RESULTS
  Fifty-seven percent of the cohort received at least one order for possible anticholinergic medications, and 28% received at least one order for definite anticholinergic medications. The incident rate for delirium was 22% of the entire cohort. After adjusting for age, sex, race, baseline SPMSQ score, and Charlson Comorbidity Index, the odds ratio (OR) for developing delirium in those with orders for possible anticholinergic medications was 0.33 (95% confidence interval (CI) = 0.10-1.03). The OR for developing delirium among those with orders for definite anticholinergic medications was 0.43 (95% CI = 0.11-1.63).
  
  
  CONCLUSIONS
  The results did not support the hypothesis that prescription of anticholinergic medications increases the risk of incident delirium in hospitalized older adults with cognitive impairment. This relationship needs to be established using prospective study designs with medication dispensing data to improve the performance of predictive models of delirium.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA. noll.campbell@wishard.edu
authors.forename: Noll
authors.initials: N
authors.lastname: Campbell
authors.forename: Anthony
authors.initials: A
authors.lastname: Perkins
authors.forename: Siu
authors.initials: S
authors.lastname: Hui
authors.forename: Babar
authors.initials: B
authors.lastname: Khan
authors.forename: Malaz
authors.initials: M
authors.lastname: Boustani
mesh_terms: D000368:Aged; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D003072:Cognition Disorders / Q000150:complications; D015331:Cohort Studies; D003693:Delirium / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D018680:Cholinergic Antagonists
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