{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:57:03Z","timestamp":1791910623555,"version":"4.3.4"},"reference-count":59,"publisher":"Oxford University Press (OUP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Objectives: to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes.<\/jats:p>\n               <jats:p>Design: electronic published and unpublished literature\/trial registries were systematically reviewed.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.<\/jats:p>\n               <jats:p>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 &lt; 0.05). Four of five included studies reported no association with delirium and increasing anti-cholinergic drug load (P &gt; 0.05). Five of the eight included studies reported a decline in physical function in users of anti-cholinergics (P &lt; 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.<\/jats:p>\n               <jats:p>Conclusion: medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function, but limited evidence exists for delirium or mortality outcomes.<\/jats:p>","DOI":"10.1093\/ageing\/afu096","type":"journal-article","created":{"date-parts":[[2014,7,19]],"date-time":"2014-07-19T20:22:10Z","timestamp":1405801330000},"page":"604-615","source":"Crossref","is-referenced-by-count":309,"title":["Effect of medications with anti-cholinergic properties on cognitive\n                    function, delirium, physical function and mortality: a systematic\n                    review"],"prefix":"10.1093","volume":"43","author":[{"given":"Chris","family":"Fox","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toby","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Maidment","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Yee","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Bua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phyo Kyaw","family":"Myint","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malaz","family":"Boustani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun Shing","family":"Kwok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Glover","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imogen","family":"Koopmans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noll","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2014,7,19]]},"reference":[{"key":"2019091011352565600_AFU096C1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.amjopharm.2006.03.008","article-title":"Anti-cholinergic medications in community-dwelling older\n                        veterans: prevalence of anti-cholinergic symptoms, symptom burden and\n                        adverse drug events","volume":"4","author":"Ness","year":"2006","journal-title":"Am J Geriatr Pharamacother"},{"key":"2019091011352565600_AFU096C2","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1001\/jama.289.9.1107","article-title":"Incidence and preventability of adverse drug events amongst older\n                        persons in the ambulatory setting","volume":"289","author":"Gurwitz","year":"2003","journal-title":"JAMA"},{"key":"2019091011352565600_AFU096C3","first-page":"225","article-title":"The cognitive impact of anti-cholinergics: a clinical\n                        review","volume":"4","author":"Campbell","year":"2009","journal-title":"Clin Interv Aging"},{"key":"2019091011352565600_AFU096C4","first-page":"639","article-title":"A systematic review of amnestic and non-amnestic mild cognitive\n                        impairment induced by anticholinergic, antihistamine, GABAergic and opioid\n                        drugs","volume":"29","author":"Tannenbaum","year":"2012","journal-title":"Drugs 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   insult to injury?","volume":"1","author":"Cruce","year":"2012","journal-title":"Mult Scler Relat Disord"},{"key":"2019091011352565600_AFU096C26","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s10654-007-9106-5","article-title":"Cardiovascular and respiratory hospitalizations and mortality\n                        among users of tiotropium in Denmark","volume":"22","author":"De Luise","year":"2007","journal-title":"Eur J Epidemiol"},{"key":"2019091011352565600_AFU096C27","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1177\/0733464810384592","article-title":"Prescribing practices of anticholinergic medications and their\n                        association with cognition in an extended care setting","volume":"31","author":"Drag","year":"2012","journal-title":"J Appl Gerontol"},{"key":"2019091011352565600_AFU096C28","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1093\/ageing\/afr102","article-title":"The impact of anticholinergic burden in 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function in older\n                        men","volume":"32","author":"Gnjidic","year":"2012","journal-title":"J Clin Psychopharmacol"},{"key":"2019091011352565600_AFU096C32","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1111\/j.1365-2125.2009.03411.x","article-title":"Drug Burden Index and physical function in older Australian\n                        men","volume":"68","author":"Gnjidic","year":"2009","journal-title":"Br J Clin Pharmacol"},{"key":"2019091011352565600_AFU096C33","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.1111\/j.1532-5415.2008.02009.x","article-title":"Cumulative anticholinergic exposure is associated with poor\n                        memory and executive function in older men","volume":"56","author":"Han","year":"2008","journal-title":"J Am Geriatr Soc"},{"key":"2019091011352565600_AFU096C34","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1007\/s00213-002-1342-5","article-title":"Changes in cognitive functioning with risperidone and olanzapine\n                        treatment: a large-scale, double-blind, randomized study","volume":"169","author":"Harvey","year":"2003","journal-title":"Psychopharmacology"},{"key":"2019091011352565600_AFU096C35","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1016\/j.amjmed.2009.02.021","article-title":"Drug Burden Index Score and functional decline in older\n                        people","volume":"122","author":"Hilmer","year":"2009","journal-title":"Am J Med"},{"key":"2019091011352565600_AFU096C36","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.eururo.2006.03.057","article-title":"Differential effects of the antimuscarinic agents darifenacin and\n                        oxybutynin ER on memory in older subjects","volume":"50","author":"Kay","year":"2006","journal-title":"Eur Urol"},{"key":"2019091011352565600_AFU096C37","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1093\/gerona\/gls176","article-title":"Cognitive effects of reducing anticholinergic drug burden in a\n                        frail elderly population: a randomized controlled trial","volume":"68","author":"Kersten","year":"2013","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2019091011352565600_AFU096C38","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1111\/j.1365-2125.2012.04411.x","article-title":"Higher anticholinergic drug scale (ADS) scores are associated\n                        with peripheral but not cognitive markers of cholinergic blockade. Cross\n                        sectional data from 21 Norwegian nursing homes","volume":"75","author":"Kersten","year":"2013","journal-title":"Br J Clin Pharmacol"},{"key":"2019091011352565600_AFU096C39","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.jamda.2008.11.005","article-title":"A preliminary study of anticholinergic burden and relationship to\n                        a quality of life indicator, engagement in activities, in nursing home\n                        residents with dementia","volume":"10","author":"Kolanowski","year":"2009","journal-title":"J Am Med Dir Assoc"},{"key":"2019091011352565600_AFU096C40","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1111\/jgs.12093","article-title":"Ten-year trajectory of potentially inappropriate medications in\n                        very old women: importance of cognitive status","volume":"61","author":"Koyama","year":"2013","journal-title":"J Am Geriatr Soc"},{"key":"2019091011352565600_AFU096C41","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1177\/0091270010368410","article-title":"Anticholinergic drug use and mortality among residents of\n                        long-term care facilities: a prospective cohort study","volume":"51","author":"Kumpula","year":"2011","journal-title":"J Clin Pharmacol"},{"key":"2019091011352565600_AFU096C42","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s40266-013-0063-2","article-title":"Anticholinergic drug use, serum anticholinergic activity, and\n                        adverse drug events among older people: a population-based\n                        study","volume":"30","author":"Lampela","year":"2013","journal-title":"Drugs Aging"},{"key":"2019091011352565600_AFU096C43","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1097\/01.ju.0000148963.21096.5d","article-title":"Assessment of cognitive function of the elderly population:\n                        effects of darifenacin","volume":"173","author":"Lipton","year":"2005","journal-title":"J Urol"},{"key":"2019091011352565600_AFU096C44","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1159\/000322883","article-title":"Anticholinergic drugs and their effects on delirium and mortality\n                        in the elderly","volume":"1","author":"Luukkanen","year":"2011","journal-title":"Dement Geriatr Cogn Dis Extra"},{"key":"2019091011352565600_AFU096C45","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.jagp.2013.01.012","article-title":"Measures of anticholinergic drug exposure, serum anticholinergic\n                        activity, and all-cause postdischarge mortality in older hospitalized\n                        patients with hip fractures","volume":"21","author":"Mangoni","year":"2013","journal-title":"Am J Geriatr Psychiatry"},{"key":"2019091011352565600_AFU096C46","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1093\/ageing\/afn240","article-title":"Use of drugs with anticholinergic effects and cognitive\n                        impairment in community-living older persons","volume":"38","author":"Merchant","year":"2009","journal-title":"Age Ageing"},{"key":"2019091011352565600_AFU096C47","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/00000542-200601000-00005","article-title":"Lorazepam is an independent risk factor for transitioning to\n                        delirium in intensive care unit patients","volume":"104","author":"Pandharipande","year":"2006","journal-title":"Anesthesiology"},{"key":"2019091011352565600_AFU096C48","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s40266-012-0044-x","article-title":"Association of anticholinergic burden with cognitive and\n                        functional status in a cohort of hospitalized elderly: comparison of the\n                        anticholinergic cognitive burden scale and anticholinergic risk scale:\n                        results from the REPOSI study","volume":"30","author":"Pasina","year":"2013","journal-title":"Drugs Aging"},{"key":"2019091011352565600_AFU096C49","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1371\/journal.pone.0064111","article-title":"Cognitive decline in older persons initiating anticholinergic\n                        medications","volume":"8","author":"Shah","year":"2013","journal-title":"PLoS ONE"},{"key":"2019091011352565600_AFU096C50","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s10286-013-0200-3","article-title":"Imidafenacin on bladder and cognitive function in neurologic OAB\n                        patients","volume":"23","author":"Sakakibara","year":"2013","journal-title":"Clin Auton Res"},{"key":"2019091011352565600_AFU096C51","doi-asserted-by":"crossref","first-page":"131","DOI":"10.2165\/11585060-000000000-00000","article-title":"Association of anticholinergic drugs with hospitalization and\n                        mortality among older cardiovascular patients: a prospective\n                        study","volume":"28","author":"Uusvaara","year":"2011","journal-title":"Drugs Aging"},{"key":"2019091011352565600_AFU096C52","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s40266-013-0055-2","article-title":"Detailed cognitive function and use of drugs with anticholinergic\n                        properties in older people: a community-based cross-sectional\n                        study","volume":"30","author":"Uusvaara","year":"2013","journal-title":"Drugs Aging"},{"key":"2019091011352565600_AFU096C53","doi-asserted-by":"crossref","first-page":"e689","DOI":"10.1016\/S1569-9056(12)60686-1","article-title":"Solifenacin and cognitive function in elderly people with mild\n                        cognitive impairment: the SENIOR study","volume":"11","author":"Wagg","year":"2012","journal-title":"Eur Urol Suppl"},{"key":"2019091011352565600_AFU096C54","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1517\/14740330903260790","article-title":"Exploratory pilot study assessing the risk of cognitive\n                        impairment or sedation in the elderly following single doses of solifenacin\n                        10 mg","volume":"8","author":"Wesnes","year":"2009","journal-title":"Expert Opin Drug Saf"},{"key":"2019091011352565600_AFU096C55","doi-asserted-by":"crossref","first-page":"253","DOI":"10.3233\/JAD-2012-110935","article-title":"Anticholinergic drugs in late life: adverse effects on cognition\n                        but not on progress to dementia","volume":"30","author":"Whalley","year":"2012","journal-title":"J Alzheimer's Dis."},{"key":"2019091011352565600_AFU096C56","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1111\/j.1532-5415.2011.03386.x","article-title":"Associations between drug burden index and falls in older people\n                        in residential aged care","volume":"59","author":"Wilson","year":"2011","journal-title":"J Am Geriatr Soc"},{"key":"2019091011352565600_AFU096C57","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1111\/ggi.12000","article-title":"Potential benefits of reducing medication-related anticholinergic\n                        burden for demented older adults: a prospective cohort study","volume":"13","author":"Yeh","year":"2013","journal-title":"Geriatr Gerontol Int"},{"key":"2019091011352565600_AFU096C58","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1002\/gps.2157","article-title":"Use of medications with anticholinergic properties and cognitive\n                        function in a young-old community 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