Skip to main content

Advertisement

SpringerLink
Log in

Anticholinergic drugs and negative outcomes in the older population: from biological plausibility to clinical evidence

  • Review
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

The use of medication with anticholinergic properties is widespread among older subjects. Many drugs of common use such as antispasmodics, bronchodilators, antiarrhythmics, antihistamines, anti-hypertensive drugs, antiparkinson agents, skeletal muscle relaxants, and psychotropic drugs have been demonstrated to have an anticholinergic activity. The most frequent adverse effects are dry mouth, nausea, vomiting, constipation, abdominal pain, urinary retention, blurred vision, tachycardia and neurologic impairment such as confusion, agitation and coma. A growing evidence from experimental studies and clinical observations suggests that drugs with anticholinergic properties can cause physical and mental impairment in the elderly population. However, the morbidity and management issues associated with unwanted anticholinergic activity are underestimated and frequently overlooked. Moreover, their possible relation with specific negative outcome in the elderly population is still not firmly established. The aim of the present review was to evaluate the relationship between the use of drugs with anticholinergic activity and negative outcomes in older persons. We searched PubMed and Cochrane combining the search terms “anticholinergic”, “delirium”, “cognitive impairment”, “falls”, “mortality” and “discontinuation”. Medicines with anticholinergic properties may increase the risks of functional and cognitive decline, morbidity, institutionalization and mortality in older people. However, such evidences are still not conclusive probably due to possible confounding factors. In particular, more studies are needed to investigate the effects of discontinuation of drug with anticholinergic properties. Overall, minimizing anticholinergic burden should always be encouraged in clinical practice to improve short-term memory, confusion and delirium, quality of life and daily functioning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. García-Gollarte F, Baleriola-Júlvez J, Ferrero-López I et al (2012) Inappropriate drug prescription at nursing home admission. J Am Med Dir Assoc 13:83.e9–83.e15

    Article  Google Scholar 

  2. Kolanowski A, Fick DM, Campbell J et al (2009) A preliminary study of anticholinergic burden and relationship to a quality of life indicator, engagement in activities, in nursing home residents with dementia. J Am Med Dir Assoc 10:252–257

    Article  PubMed Central  PubMed  Google Scholar 

  3. Mulsant BH, Pollock BG, Kirshner M et al (2003) Serum anticholinergic activity in a community-based sample of older adults: relationship with cognitive performance. Arch Gen Psychiatry 60:198–203

    Article  CAS  PubMed  Google Scholar 

  4. West T, Pruchnicki MC, Porter K et al (2013) Evaluation of anticholinergic burden of medications in older adults. J Am Pharm Assoc 53:496–504

    Article  Google Scholar 

  5. Morley JE (2011) Anticholinergic medications and cognition. J Am Med Dir Assoc 12:543–555

    Article  PubMed  Google Scholar 

  6. Landi F, Russo A, Liperoti R et al (2007) Anticholinergic drugs and physical function among frail elderly population. Clin Pharmacol Ther 81:235–241

    Article  CAS  PubMed  Google Scholar 

  7. Mintzer J, Burns A (2000) Anticholinergic side-effects of drugs in elderly people. J R Soc Med 93(9):457–462

    PubMed Central  CAS  PubMed  Google Scholar 

  8. Onder G, Landi F, Liperoti R et al (2005) Impact of inappropriate drug use among hospitalized older adults. Eur J Clin Pharmacol 61:453–459

    Article  PubMed  Google Scholar 

  9. Dilles T, Vander Stichele RH, Van Bortel LM et al (2013) The development and test of an intervention to improve ADR screening in nursing homes. J Am Med Dir Assoc 14:379.e1–379.e6

    Article  Google Scholar 

  10. Tune LE (2001) Anticholinergic effects of medication in elderly patients. J Clin Psychiatry 62(Suppl 21):11–14

    CAS  PubMed  Google Scholar 

  11. Tosato M, Landi F, Martone AM et al (2014) Potentially inappropriate drug use among hospitalised older adults: results from the CRIME study. Age Ageing 43(6):767–773. doi:10.1093/ageing/afu029

    Article  PubMed  Google Scholar 

  12. Onder G, Landi F, Cesari M et al (2003) Inappropriate medication use among hospitalized older adults in Italy: results from the Italian Group of Pharmacoepidemiology in the Elderly. Eur J Clin Pharmacol 59(2):157–162

    PubMed  Google Scholar 

  13. Tamura BK, Bell CL, Inaba M et al (2012) Outcomes of polypharmacy in nursing home residents. Clin Geriatr Med 28:217–236

    Article  PubMed  Google Scholar 

  14. Haasum Y, Fastbom J, Johnell K (2012) Institutionalization as a risk factor for inappropriate drug use in the elderly: a Swedish nationwide register-based study. Ann Pharmacother 46:339–346

    Article  PubMed  Google Scholar 

  15. Wawruch M, Macugova A, Kostkova L et al (2012) The use of medications with anticholinergic properties and risk factors for their use in hospitalized elderly patients. Pharmacoepidemiol Drug Saf 21(2):170–176. doi:10.1002/pds.2169

    Article  PubMed  Google Scholar 

  16. Agar M, Currow D, Plummer J et al (2009) Changes in anticholinergic load from regular prescribed medications in palliative care as death approaches. Palliat Med 23:257–265

    Article  CAS  PubMed  Google Scholar 

  17. Kersten H, Wyller TB (2014) Anticholinergic drug burden in older people’s brain—how well is it measured? Basic Clin Pharmacol Toxicol 114(2):151–159. doi:10.1111/bcpt.12140

    Article  CAS  PubMed  Google Scholar 

  18. Carnahan RM, Lund BC, Perry PJ et al (2006) The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol 46(12):1481–1486

    Article  CAS  PubMed  Google Scholar 

  19. Rudolph JL, Salow MJ, Angelini MC et al (2008) The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med 168:508–513

    Article  PubMed  Google Scholar 

  20. Hilmer SN, Mager DE, Simonsick EM et al (2007) A drug burden index to define the functional burden of medications in older people. Arch Intern Med 167(8):781–787

    Article  PubMed  Google Scholar 

  21. Boustani M, Baker MS, Campbell N et al (2010) Impact and recognition of cognitive impairment among hospitalized elders. J Hosp Med 5(2):69–75. doi:10.1002/jhm.589

    Article  PubMed Central  PubMed  Google Scholar 

  22. Chew ML, Mulsant BH, Pollock BG et al (2008) Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 56(7):1333–1341. doi:10.1111/j.1532-5415.2008.01737.x

    Article  PubMed  Google Scholar 

  23. Scheife R, Takeda M (2005) Central nervous system safety of anticholinergic drugs for the treatment of overactive bladder in the elderly. Clin Ther 27:144–153

    Article  CAS  PubMed  Google Scholar 

  24. Thomas C, Hestermann U, Kopitz J et al (2008) Serum anticholinergic activity and cerebral cholinergic dysfunction: an EEG study in frail elderly with and without delirium. BMC Neurosci 15(9):86. doi:10.1186/1471-2202-9-86

    Article  Google Scholar 

  25. Carnahan RM, Lund BC, Perry PJ et al (2002) A critical appraisal of the utility of the serum anticholinergic activity assay in research and clinical practice. Psychopharmacol Bull 36(2):24–39

    PubMed  Google Scholar 

  26. Flacker JM, Lipsitz LA (1999) Serum anticholinergic activity changes with acute illness in elderly medical patients. J Gerontol A Biol Sci Med Sci 54:M12–M16

    Article  CAS  PubMed  Google Scholar 

  27. Summers WK (1978) A clinical method of estimating risk of drug induced delirium. Life Sci 22:1511–1516

    Article  CAS  PubMed  Google Scholar 

  28. Han L, McCusker J, Cole M (2001) Use of medications with anticholinergic effects predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med 161:1099–1105

    Article  CAS  PubMed  Google Scholar 

  29. Durán CE, Azermai M, Vander Stichele RH (2013) Systematic review of anticholinergic risk scales in older adults. Eur J Clin Pharmacol 69(7):1485–1496. doi:10.1007/s00228-013-1499-3

    Article  PubMed  Google Scholar 

  30. Leon C, Gerretsen P, Uchida H et al (2010) Sensitivity to antipsychotic drugs in older adults. Curr Psychiatry Rep 12(1):28–33. doi:10.1007/s11920-009-0080-3

    Article  PubMed  Google Scholar 

  31. Uchida H, Mamo DC, Mulsant BH et al (2009) Increased antipsychotic sensitivity in elderly patients: evidence and mechanisms. J Clin Psychiatry 70(3):397–405

    Article  CAS  PubMed  Google Scholar 

  32. Tannenbaum C, Paquette A, Hilmer S et al (2012) A systematic review of amnestic and non-amnestic mild cognitive impairment induced by anticholinergic, antihistamine GABAergic and opioid drugs. Drugs Aging 29(8):639–658. doi:10.2165/11633250-000000000-00000

    CAS  PubMed  Google Scholar 

  33. Cancelli I, Gigli GL, Piani A et al (2008) Drugs with anticholinergic properties as a risk factor for cognitive impairment in elderly people: a population-based study. J Clin Psychopharmacol 28(6):654–659. doi:10.1097/JCP.0b013e31818ce849

    Article  PubMed  Google Scholar 

  34. Roe CM, Anderson MJ, Spivack B (2002) Use of anticholinergic medications by older adults with dementia. J Am Geriatr Soc 50(5):836–842

    Article  PubMed  Google Scholar 

  35. Giron MS, Wang HX, Bernsten C et al (2001) The appropriateness of drug use in an older non demented and demented population. J Am Geriatr Soc 49:277–283

    Article  CAS  PubMed  Google Scholar 

  36. Johnell K, Fastbom J (2008) Concurrent use of anticholinergic drugs and cholinesterase inhibitors: register-based study of over 700,000 elderly patients. Drugs Aging 25:871–877

    Article  CAS  PubMed  Google Scholar 

  37. Carnahan RM, Lund BC, Perry PJ et al (2004) The concurrent use of anticholinergics and cholinesterase inhibitors: rare event or common practice? J Am Geriatr Soc 52(12):2082–2087

    Article  PubMed  Google Scholar 

  38. Modi A, Weiner M, Craig BA et al (2009) Concomitant use of anticholinergics with acetylcholinesterase inhibitors in Medicaid recipients with dementia and residing in nursing homes. J Am Geriatr Soc 57(7):1238–1244. doi:10.1111/j.1532-5415.2009.02258.x

    Article  PubMed  Google Scholar 

  39. Gill SS, Mamdani M, Naglie G et al (2005) A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Arch Intern Med 165(7):808–813

    Article  PubMed  Google Scholar 

  40. Lu CJ, Tune LE (2003) Chronic exposure to anticholinergic medications adversely affects the course of Alzheimer disease. Am J Geriatr Psychiatry 11(4):458–461

    Article  PubMed  Google Scholar 

  41. Sink KM, Thomas J 3rd, Xu H et al (2008) Dual use of bladder anticholinergics and cholinesterase inhibitors: long-term functional and cognitive outcomes. J Am Geriatr Soc 56(5):847–853. doi:10.1111/j.1532-5415.2008.01681.x

    Article  PubMed Central  PubMed  Google Scholar 

  42. Chew ML, Mulsant BH, Pollock BG (2005) Serum anticholinergic activity and cognition in patients with moderate-to-severe dementia. Am J Geriatr Psychiatry 13(6):535–538

    Article  PubMed  Google Scholar 

  43. Cancelli I, Valentinis L, Merlino G et al (2008) Drugs with anticholinergic properties as a risk factor for psychosis in patients affected by Alzheimer’s disease. Clin Pharmacol Ther 84(1):63–68

    Article  CAS  PubMed  Google Scholar 

  44. Cancelli I, Beltrame M et al (2009) Valente M Drugs with anticholinergic properties: cognitive and neuropsychiatric side-effects in elderly patients. Neurol Sci 30(2):87–92. doi:10.1007/s10072-009-0033-y

    Article  PubMed  Google Scholar 

  45. Lechevallier-Michel N, Molimard M, Dartigues JF et al (2005) Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID Study. Br J Clin Pharmacol 59(2):143–151

    Article  PubMed Central  PubMed  Google Scholar 

  46. Cao YJ, Mager DE, Simonsick EM et al (2008) Physical and cognitive performance and burden of anticholinergics, sedatives, and ACE inhibitors in older women. Clin Pharmacol Ther 83(3):422–429

    Article  CAS  PubMed  Google Scholar 

  47. Ancelin ML, Artero S, Portet F et al (2006) Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ 332(7539):455–459

    Article  PubMed Central  PubMed  Google Scholar 

  48. Bottiggi KA, Salazar JC, Yu L et al (2006) Long-term cognitive impact of anticholinergic medications in older adults. Am J Geriatr Psychiatry 14(11):980–984

    Article  PubMed  Google Scholar 

  49. Campbell NL, Boustani MA, Lane KA et al (2010) Use of anticholinergics and the risk of cognitive impairment in an African American population. Neurology 75(2):152–159. doi:10.1212/WNL.0b013e3181e7f2ab

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  50. Jessen F, Kaduszkiewicz H, Daerr M et al (2010) Anticholinergic drug use and risk for dementia: target for dementia prevention. Eur Arch Psychiatry Clin Neurosci 260(Suppl 2):S111–S115. doi:10.1007/s00406-010-0156-4

    Article  PubMed  Google Scholar 

  51. Carrière I, Fourrier-Reglat A, Dartigues JF et al (2009) Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study. Arch Intern Med 169(14):1317–1324. doi:10.1001/archinternmed.2009.229

    Article  PubMed Central  PubMed  Google Scholar 

  52. Fox C, Richardson K, Maidment ID et al (2011) Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. J Am Geriatr Soc 59(8):1477–1483. doi:10.1111/j.1532-5415.2011.03491.x

    Article  PubMed  Google Scholar 

  53. Pasina L, Djade CD, Lucca U et al (2013) Association of anticholinergic burden with cognitive and functional status in a cohort of hospitalized elderly: comparison of the anticholinergic cognitive burden scale and anticholinergic risk scale: results from the REPOSI study. Drugs Aging 30(2):103–112. doi:10.1007/s40266-012-0044-x

    Article  CAS  PubMed  Google Scholar 

  54. Gray SL, Anderson ML, Dublin S et al (2015) Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. doi:10.1001/jamainternmed.2014.7663

    PubMed Central  Google Scholar 

  55. Han L, Agostini JV, Allore HG (2008) Cumulative anticholinergic exposure is associated with poor memory and executive function in older men. J Am Geriatr Soc 56:2203–2210

    Article  PubMed Central  PubMed  Google Scholar 

  56. Kersten H, Molden E, Willumsen T et al (2013) Higher anticholinergic drug scale (ADS) scores are associated with peripheral but not cognitive markers of cholinergic blockade. Cross sectional data from 21 Norwegian nursing homes. Br J Clin Pharmacol 75:842–849

    PubMed Central  CAS  PubMed  Google Scholar 

  57. Fleminger S (2002) Remembering delirium. Br J Psychiatry 180:4–5

    Article  PubMed  Google Scholar 

  58. Alagiakrishnan K, Wiens CA (2004) An approach to drug induced delirium in the elderly. Postgrad Med J 80(945):388–393

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  59. Lauretani F, Ceda GP, Maggio M et al (2010) Capturing side-effect of medication to identify persons at risk of delirium. Aging Clin Exp Res. 22(5–6):456–458

    Article  PubMed  Google Scholar 

  60. Zimmerman KM, Salow M, Skarf LM et al (2014) Increasing anticholinergic burden and delirium in palliative care inpatients. Palliat Med 28(4):335–341

    Article  PubMed  Google Scholar 

  61. Best O, Gnjidic D, Hilmer SN et al (2013) Investigating polypharmacy and drug burden index in hospitalised older people. Intern Med J. 43(8):912–918. doi:10.1111/imj.12203

    Article  CAS  PubMed  Google Scholar 

  62. Campbell N, Perkins A, Hui S et al (2011) Association between prescribing of anticholinergic medications and incident delirium: a cohort study. Am Geriatr Soc 59(Suppl 2):S277–S281. doi:10.1111/j.1532-5415.2011.03676.x

    Article  Google Scholar 

  63. Luukkanen MJ, Uusvaara J, Laurila JV et al (2011) Anticholinergic drugs and their effects on delirium and mortality in the elderly. Dement Geriatr Cogn Dis Extra 1(1):43–50

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  64. van Munster BC, Thomas C, Kreisel SH et al (2012) Longitudinal assessment of serum anticholinergic activity in delirium of the elderly. J Psychiatr Res 46(10):1339–1345

    Article  PubMed  Google Scholar 

  65. Watne LO, Hall RJ, Molden E et al (2014) Anticholinergic activity in cerebrospinal fluid and serum in individuals with hip fracture with and without delirium. J Am Geriatr Soc 62(1):94–102. doi:10.1111/jgs.12612

    Article  PubMed  Google Scholar 

  66. Kallin K, Gustafson Y, Sandman PO et al (2004) Drugs and falls in older people in geriatric care settings. Aging Clin Exp Res 16(4):270–276

    Article  PubMed  Google Scholar 

  67. Sylliaas H, Selbaek G, Bergland A (2012) Do behavioral disturbances predict falls among nursing home residents? Aging Clin Exp Res 24(3):251–256

    Article  PubMed  Google Scholar 

  68. Stenhagen M, Nordell E, Elmståhl S (2013) Falls in elderly people: a multifactorial analysis of risk markers using data from the Swedish general population study ‘Good ageing in Skåne’. Aging Clin Exp Res 25(1):59–67. doi:10.1007/s40520-013-0015-z

    Article  PubMed  Google Scholar 

  69. Berdot S, Bertrand M, Dartigues JF et al (2009) Inappropriate medication use and risk of falls-a prospective study in a large community-dwelling elderly cohort. BMC Geriatr 23(9):30. doi:10.1186/1471-2318-9-30

    Article  Google Scholar 

  70. Fraser LA, Adachi JD, Leslie WD et al (2014) Effect of anticholinergic medications on falls, fracture risk, and bone mineral density over a 10-year period. Ann Pharmacother 48(8):954–961

    Article  PubMed  Google Scholar 

  71. Nishtala PS, Narayan SW, Wang T et al (2014) Associations of drug burden index with falls, general practitioner visits, and mortality in older people. Pharmacoepidemiol Drug Saf 23(7):753–758. doi:10.1002/pds.3624

    Article  PubMed  Google Scholar 

  72. Dauphinot V, Faure R, Omrani S et al (2014) Exposure to anticholinergic and sedative drugs, risk of falls, and mortality: an elderly inpatient, multicenter cohort. J Clin Psychopharmacol 34(5):565–570

    Article  CAS  PubMed  Google Scholar 

  73. Landi F, Dell’Aquila G, Collamati A et al (2014) Anticholinergic drug use and negative outcomes among the frail elderly population living in a nursing home. J Am Med Dir Assoc. doi:10.1016/j.jamda.2014.08.002

    Google Scholar 

  74. Wilson NM, Hilmer SN, March LM et al (2011) Associations between drug burden index and falls in older people in residential aged care. J Am Geriatr Soc 59(5):875–880. doi:10.1111/j.1532-5415.2011.03386.x

    Article  PubMed  Google Scholar 

  75. Murphy MP, Carmine H, Kolakowsky-Hayner S (2014) Modifiable and nonmodifiable risk factors for falls after traumatic brain injury: an exploratory investigation with implications for medication use. S Rehabil Nurs 39(3):113–122. doi:10.1002/rnj.89

    Article  Google Scholar 

  76. Aizenberg D, Sigler M, Weizman A et al (2002) Anticholinergic burden and the risk of falls among elderly psychiatric inpatients: a 4-year case- control study. Int Psychogeriatr 14(3):307–310

    Article  PubMed  Google Scholar 

  77. Landi F, Russo A, Liperoti R et al (2007) Impact of inappropriate drug use on physical performance among a frail elderly population living in the community. Eur J Clin Pharmacol 63(8):791–799 Epub 2007 Jun 14

    Article  CAS  PubMed  Google Scholar 

  78. Lowry E, Woodman RJ, Soiza RL et al (2011) Associations between the anticholinergic risk scale score and physical function: potential implications for adverse outcomes in older hospitalized patients. J Am Med Dir Assoc 12(8):565–572. doi:10.1016/j.jamda.2011.03.006 Epub 2011 Apr 21

    Article  PubMed  Google Scholar 

  79. Bostock CV, Soiza RL, Mangoni AA (2013) Associations between different measures of anticholinergic drug exposure and Barthel Index in older hospitalized patients. Ther Adv Drug Saf. 4(6):235–245. doi:10.1177/2042098613500689

    Article  PubMed Central  PubMed  Google Scholar 

  80. Koshoedo S, Soiza RL, Purkayastha R et al (2012) Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation. Am J Geriatr Pharmacother 10(4):251–257. doi:10.1016/j.amjopharm.2012.06.003

    Article  PubMed  Google Scholar 

  81. Mangoni AA, van Munster BC, Woodman RJ et al (2013) Measures of anticholinergic drug exposure, serum anticholinergic activity, and all-cause postdischarge mortality in older hospitalized patients with hip fractures. Am J Geriatr Psychiatry 21(8):785–793. doi:10.1016/j.jagp.2013.01.012

    Article  PubMed  Google Scholar 

  82. Kidd AC, Musonda P, Soiza RL et al (2014) The relationship between total anticholinergic burden (ACB) and early in-patient hospital mortality and length of stay in the oldest old aged 90 years and over admitted with an acute illness. Arch Gerontol Geriatr 59(1):155–161. doi:10.1016/j.archger.2014.01.006 Epub 2014 Feb 5

    Article  CAS  PubMed  Google Scholar 

  83. Narbey D, Jolly D, Mahmoudi R et al (2013) Relationship between anticholinergic drug use and one-year outcome among elderly people hospitalized in medical wards via emergency department: the SAFES cohort study. J Nutr Health Aging. 17(9):766–771. doi:10.1007/s12603-013-0349-4

    Article  CAS  PubMed  Google Scholar 

  84. Uusvaara J, Pitkala KH, Kautiainen H et al (2011) Strandberg TE Association of anticholinergic drugs with hospitalization and mortality among older cardiovascular patients: a prospective study. Drugs Aging 28(2):131–138. doi:10.2165/11585060-000000000-00000

    Article  CAS  PubMed  Google Scholar 

  85. Kumpula EK, Bell JS, Soini H et al (2011) Anticholinergic drug use and mortality among residents of long-term care facilities: a prospective cohort study. J Clin Pharmacol 51(2):256–263. doi:10.1177/0091270010368410

    Article  CAS  PubMed  Google Scholar 

  86. Salahudeen MS, Duffull SB, Nishtala PS (2014) Impact of anticholinergic discontinuation on cognitive outcomes in older people: a systematic review. Drugs Aging 31(3):185–192. doi:10.1007/s40266-014-0158-4

    Article  CAS  PubMed  Google Scholar 

  87. Drimer T, Shahal B, Barak Y (2004) Effects of discontinuation of long-term anticholinergic treatment in elderly schizophrenia patients. Int Clin Psychopharmacol 19(1):27–29

    Article  CAS  PubMed  Google Scholar 

  88. Molloy DW, Brooymans M (1988) Anticholinergic medications and cognitive function in the elderly. J Clin Exp Gerontol 10:89–98

    Google Scholar 

  89. Tollefson GD, Montague-Clouse J, Lancaster SP (1991) The relationship of serum anticholinergic activity to mental status performance in an elderly nursing home population. J Neuropsychiatry Clin Neurosci 3:314–319

    Article  CAS  PubMed  Google Scholar 

  90. Kersten H, Molden E, Tolo IK et al (2012) Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: a randomized controlled trial. J Gerontol A Bio Sci Med Sci 68:271–278

    Article  Google Scholar 

  91. Yeh YC, Liu CL, Peng LN et al (2013) Potential benefits of reducing medication-related anticholinergic burden for demented older adults: a prospective cohort study. Geriatr Gerontol Int 13(3):694–700. doi:10.1111/ggi.12000

    Article  PubMed  Google Scholar 

  92. Gnjidic D, Le Couteur DG, Abernethy DR et al (2010) A pilot randomized clinical trial utilizing the drug burden index to reduce exposure to anticholinergic and sedative medications in older people. Ann Pharmacother 44:1725–1732

    Article  PubMed  Google Scholar 

  93. Fick DM, Cooper JW, Wade WE et al (2003) Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 163(22):2716–2724

    Article  PubMed  Google Scholar 

  94. Gallagher P, Ryan C, Byrne S et al (2008) STOPP (screening tool of older person’s prescriptions) and START (screening tool to alert doctors to right treatment). Consensus validation. Int J Clin Pharmacol Ther 46(2):72–83

    Article  CAS  PubMed  Google Scholar 

  95. Ponticelli C, Sala G, Glassock RJ (2015) Drug management in the elderly adult with chronic kidney disease: a review for the primary care physician. Mayo Clin Proc. doi:10.1016/j.mayocp.2015.01.016

    Google Scholar 

Download references

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Human and animal rights

All procedures performed in studies which involved human participants carried out by any of the authors were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the studies carried out by any of the authors when required.

Author information

Authors and Affiliations

  1. Department of Gerontology, Orthopedics and Neuroscience, Catholic University of Sacred Heart, Rome, Italy

    Agnese Collamati, Anna Maria Martone, Vincenzo Brandi, Michela Celi, Emanuele Marzetti & Francesco Landi

  2. Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy

    Andrea Poscia

  3. Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy

    Antonio Cherubini

Authors
  1. Agnese Collamati
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Maria Martone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Poscia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vincenzo Brandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michela Celi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emanuele Marzetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antonio Cherubini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Francesco Landi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Landi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Collamati, A., Martone, A.M., Poscia, A. et al. Anticholinergic drugs and negative outcomes in the older population: from biological plausibility to clinical evidence. Aging Clin Exp Res 28, 25–35 (2016). https://doi.org/10.1007/s40520-015-0359-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-015-0359-7

Keywords

Search

Navigation