Impact of anticholinergic discontinuation on cognitive outcomes in older people

A systematic review

Mohammed Saji Salahudeen, Stephen B. Duffull, Prasad S. Nishtala

Research output: Contribution to journalReview article

26 Citations (Scopus)

Abstract

Background: Medicines with anticholinergic properties increase the risks of functional and cognitive decline, morbidity and mortality, institutionalization and length of hospital stay in older people. It is postulated that minimizing anticholinergic burden should result in improved short-term memory, confusion and delirium, and may improve the quality of life and daily functioning of older people. Objective: The objective of this systematic review was to investigate the impact of discontinuing medicines with anticholinergic properties on cognitive outcomes in older people. Design: A comprehensive systematic search was performed to identify relevant studies, using Medline, Embase, International Pharmaceutical Abstracts (IPA), PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Central Register of Controlled Trials, from 1946 to July 2013. The critical appraisal was performed by two independent reviewers, and the data were extracted onto standardized forms. The primary outcome of interest was evaluation of cognitive changes in older people after anticholinergic discontinuation, measured using cognitive assessment scales. Meta-analysis was not conducted, because of the heterogeneity of the study designs, interventions and outcome measures. Results: The primary electronic literature search identified a total of 475 records in the six different databases. On the basis of full-text analysis, only four studies met the inclusion criteria. The review found two randomized control trials and two prospective cohort studies that met the inclusion criteria. Only the cohort studies demonstrated improvement of cognitive performance after discontinuation of anticholinergic medicines. Conclusions: The impact of anticholinergic discontinuation on cognitive function remains poorly researched and poorly understood. A larger sample size, longer duration of follow-up and better methods of assessing anticholinergic-induced cognitive impairment are warranted.

Original languageEnglish
Pages (from-to)185-192
Number of pages8
JournalDrugs and Aging
Volume31
Issue number3
DOIs
Publication statusPublished - 1 Mar 2014

Fingerprint

Cholinergic Antagonists
Length of Stay
Cohort Studies
Confusion
Institutionalization
Delirium
Short-Term Memory
Sample Size
Cognition
Meta-Analysis
Nursing
Quality of Life
Outcome Assessment (Health Care)
Databases
Prospective Studies
Morbidity
Mortality
Health
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Geriatrics and Gerontology
  • Medicine(all)

Cite this

Impact of anticholinergic discontinuation on cognitive outcomes in older people : A systematic review. / Salahudeen, Mohammed Saji; Duffull, Stephen B.; Nishtala, Prasad S.

In: Drugs and Aging, Vol. 31, No. 3, 01.03.2014, p. 185-192.

Research output: Contribution to journalReview article

Salahudeen, Mohammed Saji ; Duffull, Stephen B. ; Nishtala, Prasad S. / Impact of anticholinergic discontinuation on cognitive outcomes in older people : A systematic review. In: Drugs and Aging. 2014 ; Vol. 31, No. 3. pp. 185-192.
@article{98a9e87cc95b4dc2bfbf8dbd66cdadeb,
title = "Impact of anticholinergic discontinuation on cognitive outcomes in older people: A systematic review",
abstract = "Background: Medicines with anticholinergic properties increase the risks of functional and cognitive decline, morbidity and mortality, institutionalization and length of hospital stay in older people. It is postulated that minimizing anticholinergic burden should result in improved short-term memory, confusion and delirium, and may improve the quality of life and daily functioning of older people. Objective: The objective of this systematic review was to investigate the impact of discontinuing medicines with anticholinergic properties on cognitive outcomes in older people. Design: A comprehensive systematic search was performed to identify relevant studies, using Medline, Embase, International Pharmaceutical Abstracts (IPA), PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Central Register of Controlled Trials, from 1946 to July 2013. The critical appraisal was performed by two independent reviewers, and the data were extracted onto standardized forms. The primary outcome of interest was evaluation of cognitive changes in older people after anticholinergic discontinuation, measured using cognitive assessment scales. Meta-analysis was not conducted, because of the heterogeneity of the study designs, interventions and outcome measures. Results: The primary electronic literature search identified a total of 475 records in the six different databases. On the basis of full-text analysis, only four studies met the inclusion criteria. The review found two randomized control trials and two prospective cohort studies that met the inclusion criteria. Only the cohort studies demonstrated improvement of cognitive performance after discontinuation of anticholinergic medicines. Conclusions: The impact of anticholinergic discontinuation on cognitive function remains poorly researched and poorly understood. A larger sample size, longer duration of follow-up and better methods of assessing anticholinergic-induced cognitive impairment are warranted.",
author = "Salahudeen, {Mohammed Saji} and Duffull, {Stephen B.} and Nishtala, {Prasad S.}",
year = "2014",
month = "3",
day = "1",
doi = "10.1007/s40266-014-0158-4",
language = "English",
volume = "31",
pages = "185--192",
journal = "Drugs & Aging",
issn = "1170-229X",
publisher = "Springer International Publishing",
number = "3",

}

TY - JOUR

T1 - Impact of anticholinergic discontinuation on cognitive outcomes in older people

T2 - A systematic review

AU - Salahudeen, Mohammed Saji

AU - Duffull, Stephen B.

AU - Nishtala, Prasad S.

PY - 2014/3/1

Y1 - 2014/3/1

N2 - Background: Medicines with anticholinergic properties increase the risks of functional and cognitive decline, morbidity and mortality, institutionalization and length of hospital stay in older people. It is postulated that minimizing anticholinergic burden should result in improved short-term memory, confusion and delirium, and may improve the quality of life and daily functioning of older people. Objective: The objective of this systematic review was to investigate the impact of discontinuing medicines with anticholinergic properties on cognitive outcomes in older people. Design: A comprehensive systematic search was performed to identify relevant studies, using Medline, Embase, International Pharmaceutical Abstracts (IPA), PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Central Register of Controlled Trials, from 1946 to July 2013. The critical appraisal was performed by two independent reviewers, and the data were extracted onto standardized forms. The primary outcome of interest was evaluation of cognitive changes in older people after anticholinergic discontinuation, measured using cognitive assessment scales. Meta-analysis was not conducted, because of the heterogeneity of the study designs, interventions and outcome measures. Results: The primary electronic literature search identified a total of 475 records in the six different databases. On the basis of full-text analysis, only four studies met the inclusion criteria. The review found two randomized control trials and two prospective cohort studies that met the inclusion criteria. Only the cohort studies demonstrated improvement of cognitive performance after discontinuation of anticholinergic medicines. Conclusions: The impact of anticholinergic discontinuation on cognitive function remains poorly researched and poorly understood. A larger sample size, longer duration of follow-up and better methods of assessing anticholinergic-induced cognitive impairment are warranted.

AB - Background: Medicines with anticholinergic properties increase the risks of functional and cognitive decline, morbidity and mortality, institutionalization and length of hospital stay in older people. It is postulated that minimizing anticholinergic burden should result in improved short-term memory, confusion and delirium, and may improve the quality of life and daily functioning of older people. Objective: The objective of this systematic review was to investigate the impact of discontinuing medicines with anticholinergic properties on cognitive outcomes in older people. Design: A comprehensive systematic search was performed to identify relevant studies, using Medline, Embase, International Pharmaceutical Abstracts (IPA), PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Central Register of Controlled Trials, from 1946 to July 2013. The critical appraisal was performed by two independent reviewers, and the data were extracted onto standardized forms. The primary outcome of interest was evaluation of cognitive changes in older people after anticholinergic discontinuation, measured using cognitive assessment scales. Meta-analysis was not conducted, because of the heterogeneity of the study designs, interventions and outcome measures. Results: The primary electronic literature search identified a total of 475 records in the six different databases. On the basis of full-text analysis, only four studies met the inclusion criteria. The review found two randomized control trials and two prospective cohort studies that met the inclusion criteria. Only the cohort studies demonstrated improvement of cognitive performance after discontinuation of anticholinergic medicines. Conclusions: The impact of anticholinergic discontinuation on cognitive function remains poorly researched and poorly understood. A larger sample size, longer duration of follow-up and better methods of assessing anticholinergic-induced cognitive impairment are warranted.

UR - http://www.scopus.com/inward/record.url?scp=84903363295&partnerID=8YFLogxK

U2 - 10.1007/s40266-014-0158-4

DO - 10.1007/s40266-014-0158-4

M3 - Review article

VL - 31

SP - 185

EP - 192

JO - Drugs & Aging

JF - Drugs & Aging

SN - 1170-229X

IS - 3

ER -