{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T10:24:36Z","timestamp":1782901476291,"version":"3.54.5"},"reference-count":45,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T00:00:00Z","timestamp":1767484800000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["CNS Neurosci Ther"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative delirium (POD) is a common complication in elderly patients. This study aimed to investigate the association between preoperative anticholinergic drug burden and POD in elderly patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This nested case\u2013control study included patients aged \u2265\u200965\u2009years who underwent general anesthesia between April 2020 and April 2022 at multiple hospitals in China. POD occurring within 7\u2009days postoperatively was assessed using the 3\u2010Minute Diagnostic Interview for Confusion Assessment Method. Preoperative anticholinergic drug burden was quantified using the Anticholinergic Cognitive Burden (ACB) scale. Univariate and multivariate logistic regression models with random effects were used to determine the association between ACB scores and POD occurrence. Kaplan\u2013Meier survival analysis with log\u2010rank tests was plotted to compare the cumulative POD incidence across groups. Subgroup analyses were performed to explore the relationship between ACB scores and POD occurrence within specific populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 10,296 patients, 1131 (11.0%) developed POD. The study employed a 5:1 matched case\u2013control design and included 1125 cases and 5296 matched controls. Univariate (odds ratio [OR]: 1.230; 95% confidence interval [CI]: 1.119\u20131.353,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and multivariate (adjusted OR: 1.118; 95% CI: 1.006\u20131.243,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.037) analyses demonstrated a significant association between higher anticholinergic drug burden and increased POD risk. When analyzed categorically (ACB score 0 as reference), adjusted ORs were 1.100 (95% CI: 0.919\u20131.317;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.296) for ACB\u2009=\u20091, 1.213 (95% CI: 0.831\u20131.771;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.318) for ACB\u2009=\u20092, and 1.963 (95% CI: 1.253\u20133.076;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) for ACB \u2265\u20093. Kaplan\u2013Meier analysis demonstrated a significantly higher cumulative incidence of POD in the ACB \u2265\u20093 group (log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with divergence starting on postoperative day 3.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A higher preoperative anticholinergic drug burden is associated with an increased risk of POD in elderly patients, particularly when the ACB scores are \u2265\u20093.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cns.70731","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T06:20:46Z","timestamp":1767594046000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of Anticholinergic Drug Burden on Postoperative Delirium in Elderly Patients: A Nested Case\u2013Control Study"],"prefix":"10.1002","volume":"32","author":[{"given":"Ting","family":"Zhang","sequence":"first","affiliation":[{"name":"Medical School of Chinese People's Liberation Army General Hospital (PLA)  Beijing China"},{"name":"Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital  Beijing China"},{"name":"National Clinical Research Center for Geriatric Diseases Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1765-7418","authenticated-orcid":false,"given":"Tianqi","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Combat Trauma Center No. 984 Hospital of the PLA  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ningxin","family":"Li","sequence":"additional","affiliation":[{"name":"Medical School of Chinese People's Liberation Army General Hospital (PLA)  Beijing China"},{"name":"Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital  Beijing China"},{"name":"National Clinical Research Center for Geriatric Diseases Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Medical School of Chinese People's Liberation Army General Hospital (PLA)  Beijing China"},{"name":"Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital  Beijing China"},{"name":"National Clinical Research Center for Geriatric Diseases Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Medical School of Chinese People's Liberation Army General Hospital (PLA)  Beijing China"},{"name":"Department of Anesthesiology, the 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