title: Systematic review on the use of anticholinergic scales in poly pathological patients.
abstract: OBJECTIVE
  Anticholinergic drugs may increase the risk of cognitive and functional disorders in older patients. There are anticholinergic scales on which said risk is estimated. The objectives of this study are: to identify the scales described in literature that are applicable to polypathological patients and analyze their clinical outcomes.
  
  
  METHODS
  A systematic review was performed. Data sources were MEDLINE, EMBASE and Web of Science which were consulted until August 2014.
  
  
  METHODS
  (1) studies that specify the list of drugs, describe the methodology for their elaboration and how they calibrate the anticholinergic potential and (2) studies that use the scales identified as a tool to measure exposure to anticholinergic drugs in polypathological patients or those with similar characteristics. The main differences between the scales and main results on cognitive, functional and mortality status were collected.
  
  
  RESULTS
  25 articles were included. 10 scales were identified. For their preparation, 8 were based on literature about drugs with anticholinergic activity and/or previously published scales as well as expert opinions. Exposure to anticholinergic drugs has been linked to cognitive disorders (basically measured with Anticholinergic Risk Scale (ARS), Anticholinergic Cognitive Burden Scale (ACB) and Drug Burden Index (DBI)) and functional scale (with ARS and DBI). However, there is no clear relationship with mortality. The Anticholinergic Drug Scale was the only one that obtained no association with any of the variables studied.
  
  
  CONCLUSIONS
  There is a great variety of scales published and applied to older patients. The clinical results are different depending on the scale used which is probably due to the different methodology in their elaboration.
authors.affiliation: Pharmacy Service, University Hospital Virgen del Rocio, Seville, Spain. Electronic address: angelavm_21@hotmail.com.
authors.forename: Angela Maria
authors.initials: AM
authors.lastname: Villalba-Moreno
authors.affiliation: Andalusian Agency for Health Technology Assessment, Seville, Spain.
authors.forename: Eva Rocío
authors.initials: ER
authors.lastname: Alfaro-Lara
authors.affiliation: Department of Pharmacology, Faculty of Pharmacy, Seville, Spain.
authors.forename: Maria Concepción
authors.initials: MC
authors.lastname: Pérez-Guerrero
authors.affiliation: Internal Medicine Service, University Hospital Virgen del Rocio, Seville, Spain.
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Nieto-Martín
authors.affiliation: Pharmacy Service, University Hospital Virgen de Valme, Seville, Spain.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Santos-Ramos
mesh_terms: D000368:Aged; D018680:Cholinergic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D008297:Male; D012306:Risk; D018570:Risk Assessment
chemical_list: D018680:Cholinergic Antagonists
keywords: Anticholinergic drugs; Chronic patients; Cognition disorders; Multimorbidity; Polypathological patient; Scales