title: Anticholinergic Exposure During Rehabilitation: Cognitive and Physical Function Outcomes in Patients with Delirium Superimposed on Dementia.
abstract: OBJECTIVE
  We examined the association between anticholinergic medication exposure and subsequent cognitive and physical function in patients with delirium superimposed on dementia during rehabilitation. We also examined length of stay and discharge disposition by anticholinergic medication exposure.
  
  
  METHODS
  In this secondary analysis we used control group data from an ongoing randomized clinical trial.
  
  
  METHODS
  Participants with delirium and dementia were enrolled at admission to post-acute care. These 99 participants had a mean age of 86.11 (±6.83) years; 67.6% were women; 98% were Caucasian; and 33% were positive for at least one APOE e4 allele.
  
  
  METHODS
  We obtained daily measures of cognitive and physical function using: Digit Span; memory, orientation and attention items from the Montreal Cognitive Assessment; CLOX; the Confusion Assessment Method; and the Barthel Index. Anticholinergic medication exposure was measured weekly using the Anticholinergic Cognitive Burden Scale.
  
  
  RESULTS
  Using multilevel models for time we found that greater use of clinically relevant anticholinergic medications in the previous week reduced cognitive and physical function, as measured by Digit Span Backwards and the Barthel index, in the current week. There was no effect of anticholinergic medication use on delirium severity, and APOE status did not moderate any outcomes. Greater use of clinically relevant anticholinergic medications was related to longer length of stay but not discharge disposition.
  
  
  CONCLUSIONS
  For vulnerable older adults, anticholinergic exposure represents a potentially modifiable risk factor for poor attention, working memory, physical function, and greater length of stay during rehabilitation.
authors.affiliation: College of Nursing, Penn State, University Park, PA, USA. Electronic address: amk20@psu.edu.
authors.forename: Ann
authors.initials: A
authors.lastname: Kolanowski
authors.affiliation: College of Nursing, Penn State, University Park, PA, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Mogle
authors.affiliation: College of Nursing, Penn State, University Park, PA, USA.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Fick
authors.affiliation: Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN, USA.
authors.forename: Noll
authors.initials: N
authors.lastname: Campbell
authors.affiliation: College of Nursing, Penn State, University Park, PA, USA.
authors.forename: Nikki
authors.initials: N
authors.lastname: Hill
authors.affiliation: College of Nursing, Penn State, University Park, PA, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Mulhall
authors.affiliation: College of Nursing, Penn State, University Park, PA, USA.
authors.forename: Liza
authors.initials: L
authors.lastname: Behrens
authors.affiliation: College of Nursing, Penn State, University Park, PA, USA.
authors.forename: Elise
authors.initials: E
authors.lastname: Colancecco
authors.affiliation: Regenstrief Institute, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Malaz
authors.initials: M
authors.lastname: Boustani
authors.affiliation: REACH: The Centre for Research in Ageing and Cognitive Health, College of Life and Environmental Sciences, Department of Psychology, Washington Singer Laboratories, Exeter, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Clare
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D001288:Attention / Q000187:drug effects; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D003071:Cognition / Q000187:drug effects*; D003693:Delirium / Q000150:complications / Q000534:rehabilitation*; D003704:Dementia / Q000150:complications / Q000534:rehabilitation*; D005260:Female; D006304:Health Status; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008568:Memory / Q000187:drug effects; D012307:Risk Factors
chemical_list: D018680:Cholinergic Antagonists
keywords: Anticholinergic exposure; cognition; dementia; physical function; post-acute care