title: Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: a systematic review.
abstract: OBJECTIVE
  to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes.
  
  
  METHODS
  electronic published and unpublished literature/trial registries were systematically reviewed.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.
  
  
  CONCLUSIONS
  medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function, but limited evidence exists for delirium or mortality outcomes.
authors.affiliation: School of Medicine, University of East Anglia, Norwich, Norfolk NR47TJ, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Fox
authors.affiliation: School of Rehabilitation Sciences, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK.
authors.forename: Toby
authors.initials: T
authors.lastname: Smith
authors.affiliation: Pharmacy, School of Life and Health Sciences, Medicines and Devices in Ageing, Aston Research Centre for Healthy Ageing, (ARCHA), Aston University, Birmingham, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Maidment
authors.affiliation: School of Medicine, University of East Anglia, Norwich, Norfolk NR47TJ, UK.
authors.forename: Wei-Yee
authors.initials: WY
authors.lastname: Chan
authors.affiliation: School of Medicine, University of East Anglia, Norwich, Norfolk NR47TJ, UK.
authors.forename: Nelson
authors.initials: N
authors.lastname: Bua
authors.affiliation: School of Medicine & Dentistry, University of Aberdeen, Aberdeen, Scotland AB25 2ZD, UK.
authors.forename: Phyo Kyaw
authors.initials: PK
authors.lastname: Myint
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Malaz
authors.initials: M
authors.lastname: Boustani
authors.affiliation: Norfolk and Norwich University Hospital, Norwich, Norfolk NR4 7UY, UK.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: School of Medicine, University of East Anglia, Norwich, Norfolk NR47TJ, UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: Glover
authors.affiliation: School of Medicine, University of East Anglia, Norwich, Norfolk NR47TJ, UK.
authors.forename: Imogen
authors.initials: I
authors.lastname: Koopmans
authors.affiliation: Purdue University, IN, USA.
authors.forename: Noll
authors.initials: N
authors.lastname: Campbell
mesh_terms: D018680:Cholinergic Antagonists / Q000009:adverse effects*; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D003693:Delirium / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D006304:Health Status; D006801:Humans; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D018680:Cholinergic Antagonists
keywords: adverse effect; anti-cholinergic; anti-muscarinic; cholinergic antagonist; cognition; function; mortality; older people; systematic review