Anticholinergic burden (prognostic factor) for prediction of dementia or cognitive decline in older adults with no known cognitive syndrome (Review)

Martin Taylor-Rowan, Sophie Edwards, Anna H Noel-Storr, Jenny McCleery, Phyo K Myint, Roy Soiza, Carrie Stewart, Yoon Kong Loke, Terry J Quinn* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Medications with anticholinergic properties are commonly prescribed to older adults. The cumulative anticholinergic eFect of all the medications a person takes is referred to as the 'anticholinergic burden' because of its potential to cause adverse eFects. It is possible that high anticholinergic burden may be a risk factor for development of cognitive decline or dementia. There are various scales available to measure anticholinergic burden but agreement between them is oKen poor.
To assess whether anticholinergic burden, as defined at the level of each individual scale, is a prognostic factor for future cognitive decline or dementia in cognitively unimpaired older adults.
Search methods
We searched the following databases from inception to 24 March 2021: MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCOhost), and ISI Web of Science Core Collection (ISI Web of Science).
Selection criteria
We included prospective and retrospective longitudinal cohort and case-control observational studies with a minimum of one year' follow up that examined the association between an anticholinergic burden measurement scale and future cognitive decline or dementia in cognitively unimpaired older adults.
Data collection and analysis
Two review authors independently assessed studies for inclusion, and undertook data extraction, assessment of risk of bias, and GRADE assessment. We extracted odds ratios (OR) andhazard ratios, with 95%confidence intervals (CI), and linear data on the association between anticholinergic burden and cognitive decline or dementia. We intended to pool each metric separately; however, only OR-based data were suitable for pooling via a random-eFects meta-analysis. We initially established adjusted and unadjusted pooled rates for each available
anticholinergic scale; then, as an exploratory analysis, established pooled rates on the prespecified association across scales. We examined variability based on severity of anticholinergic burden
Original languageEnglish
Article numberCD013540
Number of pages71
JournalCochrane Database of Systematic Reviews
Issue number4
Publication statusPublished - 5 May 2021

Bibliographical note

Funding Information:
National Institute on Aging, NIH Grants, and the Branta Foundation

Funding Information:
We followed best practice in design, conduct, and reporting of our prognosis review as detailed in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2019). The review was supported by the Cochrane Prognostic Methods Group, partners within the Cochrane Mental Health and Neuroscience Network, and the UK National Institute for Health Research Complex Reviews Support Unit (NIHR CRSU).

Funding Information:
American Philosophical Society, the National Institute on Aging grants, and by the Illinois Department of Public Health to DAB

Funding Information:
This protocol was supported by the National Institute for Health Research (NIHR), via Cochrane Infrastructure funding to the Cochrane Dementia and Cognitive Improvement group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service or the Department of Health

Publisher Copyright:
Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.


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