Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: a systematic review

Age Ageing. 2014 Sep;43(5):604-15. doi: 10.1093/ageing/afu096. Epub 2014 Jul 19.


Objectives: to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes.

Design: electronic published and unpublished literature/trial registries were systematically reviewed.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.

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 < 0.05). Four of five included studies reported no association with delirium and increasing anti-cholinergic drug load (P > 0.05). Five of the eight included studies reported a decline in physical function in users of anti-cholinergics (P < 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.

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.

Keywords: adverse effect; anti-cholinergic; anti-muscarinic; cholinergic antagonist; cognition; function; mortality; older people; systematic review.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Cholinergic Antagonists / adverse effects*
  • Cognition / drug effects*
  • Cognition Disorders / chemically induced*
  • Cognition Disorders / diagnosis
  • Cognition Disorders / mortality
  • Cognition Disorders / psychology
  • Delirium / chemically induced*
  • Delirium / diagnosis
  • Delirium / mortality
  • Delirium / psychology
  • Health Status*
  • Humans
  • Prognosis
  • Risk Assessment
  • Risk Factors


  • Cholinergic Antagonists