Impact of Anticholinergic Discontinuation on Cognitive Outcomes in Older People: A Systematic Review
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,...
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| Veröffentlicht in: | Drugs & aging 2014-03, Vol.31 (3), p.185-192 |
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| creator | Salahudeen, Mohammed Saji Duffull, Stephen B. Nishtala, Prasad S. |
| description | 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. |
| doi_str_mv | 10.1007/s40266-014-0158-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1610838503</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3459526991</sourcerecordid><originalsourceid>FETCH-LOGICAL-c472t-2c215b84ef518ab970a1f91062934212029484534fb5140f3237949115102e233</originalsourceid><addsrcrecordid>eNp1kF1rFDEUhoNYbK3-AG8kIF6OPedMMjPxbtn6USis-AHehWw2s6bMJGsy09J_b9bdqjdCQkLyvOccHsZeILxBgPYiC6CmqQBF2bKrxCN2htiqClWjHv--Q0Wkvp-ypznfAEBDhE_YKQlJDan6jG2uxp2xE489X4TJ2x9x8MGlrbf80mcby1uYzeRj4GUt4zb4yd86vponG0eXuQ98NWxc4p9c3A3uLV_wL_d5cmMJWf7Z3Xp394yd9GbI7vnxPGff3r_7uvxYXa8-XC0X15UVLU0VWUK57oTrJXZmrVow2CuE_aSCkICU6ISsRb-WKKCvqW6VUIgSgRzV9Tl7dai7S_Hn7PKkb-KcQmmpsUHo6k7CnsIDZVPMOble75IfTbrXCHrvVR-86uJV771qUTIvj5Xn9eg2fxIPIgvw-giYbM3QJxOsz3-5jiTItiscHbhcvsLWpX9G_G_3XzonjYA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1610838503</pqid></control><display><type>article</type><title>Impact of Anticholinergic Discontinuation on Cognitive Outcomes in Older People: A Systematic Review</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Salahudeen, Mohammed Saji ; Duffull, Stephen B. ; Nishtala, Prasad S.</creator><creatorcontrib>Salahudeen, Mohammed Saji ; Duffull, Stephen B. ; Nishtala, Prasad S.</creatorcontrib><description>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.</description><identifier>ISSN: 1170-229X</identifier><identifier>EISSN: 1179-1969</identifier><identifier>DOI: 10.1007/s40266-014-0158-4</identifier><identifier>PMID: 24526293</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Aged ; Biological and medical sciences ; Cholinergic Antagonists - adverse effects ; Cholinergic Antagonists - therapeutic use ; Cognition - drug effects ; Cognition Disorders - chemically induced ; Geriatrics/Gerontology ; Humans ; Internal Medicine ; Medical sciences ; Medicine ; Medicine & Public Health ; Pharmacology. Drug treatments ; Pharmacology/Toxicology ; Pharmacotherapy ; Systematic Review</subject><ispartof>Drugs & aging, 2014-03, Vol.31 (3), p.185-192</ispartof><rights>Springer International Publishing Switzerland 2014</rights><rights>2015 INIST-CNRS</rights><rights>Copyright Wolters Kluwer Health Adis International Mar 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c472t-2c215b84ef518ab970a1f91062934212029484534fb5140f3237949115102e233</citedby><cites>FETCH-LOGICAL-c472t-2c215b84ef518ab970a1f91062934212029484534fb5140f3237949115102e233</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40266-014-0158-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40266-014-0158-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28250578$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24526293$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Salahudeen, Mohammed Saji</creatorcontrib><creatorcontrib>Duffull, Stephen B.</creatorcontrib><creatorcontrib>Nishtala, Prasad S.</creatorcontrib><title>Impact of Anticholinergic Discontinuation on Cognitive Outcomes in Older People: A Systematic Review</title><title>Drugs & aging</title><addtitle>Drugs Aging</addtitle><addtitle>Drugs Aging</addtitle><description>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.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cholinergic Antagonists - adverse effects</subject><subject>Cholinergic Antagonists - therapeutic use</subject><subject>Cognition - drug effects</subject><subject>Cognition Disorders - chemically induced</subject><subject>Geriatrics/Gerontology</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Pharmacology. Drug treatments</subject><subject>Pharmacology/Toxicology</subject><subject>Pharmacotherapy</subject><subject>Systematic Review</subject><issn>1170-229X</issn><issn>1179-1969</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kF1rFDEUhoNYbK3-AG8kIF6OPedMMjPxbtn6USis-AHehWw2s6bMJGsy09J_b9bdqjdCQkLyvOccHsZeILxBgPYiC6CmqQBF2bKrxCN2htiqClWjHv--Q0Wkvp-ypznfAEBDhE_YKQlJDan6jG2uxp2xE489X4TJ2x9x8MGlrbf80mcby1uYzeRj4GUt4zb4yd86vponG0eXuQ98NWxc4p9c3A3uLV_wL_d5cmMJWf7Z3Xp394yd9GbI7vnxPGff3r_7uvxYXa8-XC0X15UVLU0VWUK57oTrJXZmrVow2CuE_aSCkICU6ISsRb-WKKCvqW6VUIgSgRzV9Tl7dai7S_Hn7PKkb-KcQmmpsUHo6k7CnsIDZVPMOble75IfTbrXCHrvVR-86uJV771qUTIvj5Xn9eg2fxIPIgvw-giYbM3QJxOsz3-5jiTItiscHbhcvsLWpX9G_G_3XzonjYA</recordid><startdate>20140301</startdate><enddate>20140301</enddate><creator>Salahudeen, Mohammed Saji</creator><creator>Duffull, Stephen B.</creator><creator>Nishtala, Prasad S.</creator><general>Springer International Publishing</general><general>Adis International</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope></search><sort><creationdate>20140301</creationdate><title>Impact of Anticholinergic Discontinuation on Cognitive Outcomes in Older People: A Systematic Review</title><author>Salahudeen, Mohammed Saji ; Duffull, Stephen B. ; Nishtala, Prasad S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c472t-2c215b84ef518ab970a1f91062934212029484534fb5140f3237949115102e233</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cholinergic Antagonists - adverse effects</topic><topic>Cholinergic Antagonists - therapeutic use</topic><topic>Cognition - drug effects</topic><topic>Cognition Disorders - chemically induced</topic><topic>Geriatrics/Gerontology</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Pharmacology. Drug treatments</topic><topic>Pharmacology/Toxicology</topic><topic>Pharmacotherapy</topic><topic>Systematic Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Salahudeen, Mohammed Saji</creatorcontrib><creatorcontrib>Duffull, Stephen B.</creatorcontrib><creatorcontrib>Nishtala, Prasad S.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><jtitle>Drugs & aging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Salahudeen, Mohammed Saji</au><au>Duffull, Stephen B.</au><au>Nishtala, Prasad S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Anticholinergic Discontinuation on Cognitive Outcomes in Older People: A Systematic Review</atitle><jtitle>Drugs & aging</jtitle><stitle>Drugs Aging</stitle><addtitle>Drugs Aging</addtitle><date>2014-03-01</date><risdate>2014</risdate><volume>31</volume><issue>3</issue><spage>185</spage><epage>192</epage><pages>185-192</pages><issn>1170-229X</issn><eissn>1179-1969</eissn><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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>24526293</pmid><doi>10.1007/s40266-014-0158-4</doi><tpages>8</tpages></addata></record> |
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| ispartof | Drugs & aging, 2014-03, Vol.31 (3), p.185-192 |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Aged Biological and medical sciences Cholinergic Antagonists - adverse effects Cholinergic Antagonists - therapeutic use Cognition - drug effects Cognition Disorders - chemically induced Geriatrics/Gerontology Humans Internal Medicine Medical sciences Medicine Medicine & Public Health Pharmacology. Drug treatments Pharmacology/Toxicology Pharmacotherapy Systematic Review |
| title | Impact of Anticholinergic Discontinuation on Cognitive Outcomes in Older People: A Systematic Review |
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