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Review
. 2023 Dec 8;12(12):CD015405.
doi: 10.1002/14651858.CD015405.pub2.

Anticholinergic deprescribing interventions for reducing risk of cognitive decline or dementia in older adults with and without prior cognitive impairment

Martin Taylor-Rowan  1 , Ahmed A Alharthi  1   2 , Anna H Noel-Storr  3 , Phyo K Myint  4 , Carrie Stewart  5 , Jenny McCleery  6 , Terry J Quinn  1
Affiliations
Review

Anticholinergic deprescribing interventions for reducing risk of cognitive decline or dementia in older adults with and without prior cognitive impairment

Martin Taylor-Rowan et al. Cochrane Database Syst Rev. .

Abstract

Background: Anticholinergics are medications that block the action of acetylcholine in the central or peripheral nervous system. Medications with anticholinergic properties are commonly prescribed to older adults. The cumulative anticholinergic effect of all the medications a person takes is referred to as the anticholinergic burden. A high anticholinergic burden may cause cognitive impairment in people who are otherwise cognitively healthy, or cause further cognitive decline in people with pre-existing cognitive problems. Reducing anticholinergic burden through deprescribing interventions may help to prevent onset of cognitive impairment or slow the rate of cognitive decline.

Objectives: Primary objective • To assess the efficacy and safety of anticholinergic medication reduction interventions for improving cognitive outcomes in cognitively healthy older adults and older adults with pre-existing cognitive issues. Secondary Objectives • To compare the effectiveness of different types of reduction interventions (e.g. pharmacist-led versus general practitioner-led, educational versus audit and feedback) for reducing overall anticholinergic burden. • To establish optimal duration of anticholinergic reduction interventions, sustainability, and lessons learnt for upscaling • To compare results according to differing anticholinergic scales used in medication reduction intervention trials • To assess the efficacy of anticholinergic medication reduction interventions for improving other clinical outcomes, including mortality, quality of life, clinical global impression, physical function, institutionalisation, falls, cardiovascular diseases, and neurobehavioral outcomes.

Search methods: We searched CENTRAL on 22 December 2022, and we searched MEDLINE, Embase, and three other databases from inception to 1 November 2022.

Selection criteria: We included randomised controlled trials (RCTs) of interventions that aimed to reduce anticholinergic burden in older people and that investigated cognitive outcomes.

Data collection and analysis: Two review authors independently assessed studies for inclusion, extracted data, and assessed the risk of bias of included studies. The data were not suitable for meta-analysis, so we summarised them narratively. We used GRADE methods to rate our confidence in the review results.

Main results: We included three trials with a total of 299 participants. All three trials were conducted in a cognitively mixed population (some cognitively healthy participants, some participants with dementia). Outcomes were assessed after one to three months. One trial reported significantly improved performance on the Digit Symbol Substitution Test (DSST) in the intervention group (treatment difference 0.70, 95% confidence interval (CI) 0.11 to 1.30), although there was no difference between the groups in the proportion of participants with reduced anticholinergic burden. Two trials successfully reduced anticholinergic burden in the intervention group. Of these, one reported no significant difference between the intervention versus control in terms of their effect on cognitive performance measured by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) immediate recall (mean between-group difference 0.54, 95% CI -0.91 to 2.05), CERAD delayed recall (mean between-group difference -0.23, 95% CI-0.85 to 0.38), CERAD recognition (mean between-group difference 0.77, 95% CI -0.39 to 1.94), and Mini-Mental State Examination (mean between-group difference 0.39, 95% CI -0.96 to 1.75). The other trial reported a significant correlation between anticholinergic burden and a test of working memory after the intervention (which suggested reducing the burden improved performance), but reported no effect on multiple other cognitive measures. In GRADE terms, the results were of very low certainty. There were no reported between-group differences for any other clinical outcome we investigated. It was not possible to investigate differences according to type of reduction intervention or type of anticholinergic scale, to measure the sustainability of interventions, or to establish lessons learnt for upscaling. No trials investigated safety outcomes.

Authors' conclusions: There is insufficient evidence to reach any conclusions on the effects of anticholinergic burden reduction interventions on cognitive outcomes in older adults with or without prior cognitive impairment. The evidence from RCTs was of very low certainty so cannot support or refute the hypothesis that actively reducing or stopping prescription of medications with anticholinergic properties can improve cognitive outcomes in older people. There is no evidence from RCTs that anticholinergic burden reduction interventions improve other clinical outcomes such as mortality, quality of life, clinical global impression, physical function, institutionalisation, falls, cardiovascular diseases, or neurobehavioral outcomes. Larger RCTs investigating long-term outcomes are needed. Future RCTs should also investigate potential benefits of anticholinergic reduction interventions in cognitively healthy populations and cognitively impaired populations separately.

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Conflict of interest statement

MT: none AA: none AN‐S: none PM: none CS: none JM: none TQ: none

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  • doi: 10.1002/14651858.CD015405

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References

References to studies included in this review

Kersten 2013 {published data only}
    1. Kersten H, Molden E, Tolo IK, Skovlund E, Engedal K, Wyller TB. Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: a randomized controlled trial. Journals of Gerontology: MEDICAL SCIENCES 2013;68(3):271-8. [DOI: 10.1093/gerona/gls176] - DOI - PubMed
Tollefson 1991 {published data only}
    1. Tollefson GD, Montague-Clouse J, Lancaster SP. The relationship of serum anticholinergic activity to mental status performance in an elderly nursing home population. The Journal of Neuropsychiatry and Clinical Neurosciences 1991;3:314-9. - PubMed
van der Meer 2018 {published data only}
    1. Van der Meer HG, Wouters H, Pont LG, Taxis K. Reducing the anticholinergic and sedative load in older patients on polypharmacy by pharmacist-led medication review: a randomised controlled trial. BMJ Open 2018;8:e019042. [DOI: 10.1136/ bmjopen-2017-019042] - PMC - PubMed

References to studies excluded from this review

Ailabouni 2017 {published data only}
    1. Ailabouni N, Mangin D, Nishtala PS. Deprescribing anticholinergic and sedative medicines: protocol for a feasibility trial (DEFEAT-polypharmacy) in residential aged care facilities. BMJ Open 2017;7(4):e013800. [DOI: 10.1136/bmjopen-2016-013800] - DOI - PMC - PubMed
Anda 2021 {published data only}
    1. Anda L, Johnsen E, Kroken RA, Joa I, Rettenbacher M, Løberg EM. Cognitive change and antipsychotic medications: results from a pragmatic rater-blind RCT. Schizophrenia Research: Cognition 2021;26:100204. [PMID: ] - PMC - PubMed
Buckley 2021 {published data only}
    1. Buckley E, Jonsson A, Flood Z, Lavelle M, O'Sullivan N, et al. Potentially inappropriate medication use and mortality in patients with cognitive impairment. Age and Ageing 2021;50(Suppl 2):2013-2020. [DOI: 10.1093/ageing/afab118.09] - DOI - PubMed
Campbell 2019 {published data only}
    1. Campbell NL, Perkins AJ, Khan BA, Gao S, Farber MO, Khan S, et al. Deprescribing in the Pharmacologic Management of Delirium: a Randomized Trial in the Intensive Care Unit. Journal of the American Geriatrics Society 2019;67(4):695-702. [DOI: 10.1111/jgs.15751] - DOI - PMC - PubMed
Cooper 1992 {published data only}
    1. Cooper JA, Sagar HJ, Doherty SM, Jordan N, Tidswell P, Sullivan EV. Different effects of dopaminergic and anticholinergic therapies on cognitive and motor function in Parkinson's disease. A follow-up study of untreated patients. Brain 1992;115:1701-25. [PMID: ] - PubMed
Desmarais 2014 {published data only}
    1. Desmarais JE, Beauclair L, Annable L, Bélanger MC, Kolivakis TT, Margolese HC. Effects of discontinuing anticholinergic treatment on movement disorders, cognition and psychopathology in patients with schizophrenia. Therapeutic Advances in Pharmacology 2014;4(6):257-67. [PMID: ] - PMC - PubMed
Drimer 2004 {published data only}
    1. Drimer T, Shahal B, Barak Y. Effects of discontinuation of long-term anticholinergic treatment in elderly schizophrenia patients. International Clinical Psychopharmacology 2004;19(1):27-9. [PMID: ] - PubMed
Forns 2021 {published data only}
    1. Forns J, Aguado J, Rivero-Ferrer E, Plana E, Dickerman B, De Albeniz XG. The effect of the anticholinergic properties of antidepressants on the incidence of dementia: a target trial emulation. Pharmacoepidemiology and Drug Safety 2021;Conference: 37th International Conference on Pharmacoepidemiology and Therapeutic Risk Management:84.
Geller 2012 {published data only}
    1. Geller EJ, Crane AK, Wells EC, Robinson BL, Jannelli ML, Khandelwal CM, et al. Effect of Anticholinergic Use for the Treatment of Overactive Bladder on Cognitive Function in Post-Menopausal Women. Clinical Drug Investigation 2012;32(10):697-705. [PMID: ] - PMC - PubMed
Griebling 2020 {published data only}
    1. Griebling TL, Campbell NL, Mangel J, Staskin D, Herschorn S, Elsouda D, et al. Effect of mirabegron on cognitive function in elderly patients with overactive bladder: moCA results from a phase 4 randomized, placebo-controlled study (PILLAR). BMC Geriatrics 2020;20(1):109. [PMID: ] - PMC - PubMed
Gustafsson 2018 {published data only}
    1. Gustafsson M, Sjolander M, Pfister B, Schneede J, Lovheim H. Effects of pharmacists' interventions on inappropriate drug use and drug-related readmissions in people with dementia-a secondary analysis of a randomized controlled trial. Pharmacy 2018;6(1):7. [PMID: ] - PMC - PubMed
High 2020 {published data only}
    1. High RA, Danford JM, Shi ZY, Karmonik C, Kuehl TJ, Bird ET, et al. Protocol for a multicenter randomized, double blind, controlled pilot trial of higher neural function in overactive bladder patients after anticholinergic, beta-3 adrenergic agonist, or placebo. Contemporary Clinical Trials Communication 2020;20:100690. [PMID: ] - PMC - PubMed
Jaidi 2018 {published data only}
    1. Jaidi Y, Nonnonhou V, Kanagaratnam L, Bertholon LA, Badr S, Noel V, et al. Reduction of the Anticholinergic Burden Makes It Possible to Decrease Behavioral and Psychological Symptoms of Dementia. American Journal of Geriatric Psychiatry 2018;26(3):280-8. [DOI: 10.1016/j.jagp.2017.08.005] - DOI - PubMed
Jaidi 2019 {published data only}
    1. Jaïdi Y, Guilloteau A, Nonnonhou V, Bertholon LA, Badr S, Morrone I, et al. Threshold for a reduction in anticholinergic burden to decrease behavioral and psychological symptoms of dementia. Journal of the American Medical Directors Association 2019;20(2):159-64. [PMID: ] - PubMed
Karatas 2010 {published data only}
    1. Karatas GK, Gunendi Z. Do anticholinergics affect reaction time? A possible impact on the course of rehabilitation. NeuroRehabilitation 2010;27(2):141-5. [DOI: 10.3233/NRE20100590] - DOI - PubMed
Lim 2020 {published data only}
    1. Lim R, Bereznicki L, Corlis M, Kalisch Ellett LM, Kang AC, Merlin T, et al. Reducing medicine-induced deterioration and adverse reactions (ReMInDAR) trial: study protocol for a randomised controlled trial in residential aged-care facilities assessing frailty as the primary outcome. BMJ Open 2020;10(4):e032851. [DOI: 10.1136/bmjopen-2019-032851] - DOI - PMC - PubMed
Lupu 2017 {published data only}
    1. Lupu AM, Clinebell K, Gannon JM, Ellison JC, Chengappa KNR. Reducing anticholinergic medication burden in patients with psychotic or bipolar disorders. Journal of Clinical Psychiatry 2017;78(9):e1270-5. - PubMed
Lupu 2021 {published data only}
    1. Lupu AM, MacCamy KL, Gannon JM, Brar JS, Chengappa KN. Less is more: deprescribing anticholinergic medications in persons with severe mental illness. Annals of Clinical Psychiatry 2021;33(2):80-92. [DOI: 10.12788/acp.0019] - DOI - PubMed
McEvoy 1987 {published data only}
    1. McEvoy JP. A double-blind crossover comparison of antiparkinson drug therapy: amantadine versus anticholinergics in 90 normal volunteers, with an emphasis on differential effects on memory function. Journal of Clinical Psychiatry 1987;48:20-3. - PubMed
Moga 2017 {published data only}
    1. Moga DC, Abner EL, Rigsby DN, Eckmann L, Huffmyer M, Murphy RR, et al. Optimizing medication appropriateness in older adults: a randomized clinical interventional trial to decrease anticholinergic burden. Alzheimer's Research & Therapy 2017;9(1):36. [PMID: ] - PMC - PubMed
Molloy 1989 {published data only}
    1. Molloy DW, Brooymans M. Anticholinergic medications and cognitive function in the elderly. Journal of Clinical and Experimental Gerontology 1989;10:89-98.
Oken 1994 {published data only}
    1. Oken BS, Kishiyama SS, Kaye JA, Howieson DB. Attention deficit in Alzheimer's disease is not simulated by an anticholinergic/antihistaminergic drug and is distinct from deficits in healthy aging. Neurology 1994;44(4):657-62. - PubMed
Potter 2016 {published data only}
    1. Potter K, Flicker L, Page A, Etherton-Beer C. Deprescribing in frail older people: a randomised controlled trial. PLOS One 2016;11(3):e0149984. [PMID: ] - PMC - PubMed
Roughead 2022 {published data only}
    1. Roughead EE, Pratt NL, Parfitt G, Rowett D, Kalisch-Ellett LM, Bereznicki L, et al. Effect of an ongoing pharmacist service to reduce medicine-induced deterioration and adverse reactions in aged-care facilities (nursing homes): a multicentre, randomised controlled trial (the ReMInDAR trial). Age and Ageing 2022;51(4):1-9. [DOI: 10.1093/ageing/afac092] - DOI - PMC - PubMed
Sathienluckana 2018 {published data only}
    1. Sathienluckana T, Unaharassamee W, Suthisisang C, Suanchang O, Suansanae T. Anticholinergic discontinuation and cognitive functions in patients with schizophrenia: a pharmacist-physician collaboration in the outpatient department. Integrated Pharmacy Research and Practice 2018;7:161-71. [PMID: ] - PMC - PubMed
Sunderland 1987 {published data only}
    1. Sunderland T, Tariot PN, Cohen RM, Weingartner H, Mueller EA, Murphy DL. Anticholinergic sensitivity in patients with dementia of the Alzheimer type and age-matched controls. A dose-response study. Archives of General Psychiatry 1987;44(5):418-26. [DOI: 10.1001/archpsyc.1987.01800170032006] - DOI - PubMed
Veselinovic 2015 {published data only}
    1. Veselinovic T, Vernaleken I, Janouschek H, Kellermann T, Paulzen M, Cumming P, et al. Effects of anticholinergic challenge on psychopathology and cognition in drug-free patients with schizophrenia and healthy volunteers. Psychopharmacology 2015;232(9):1607-17. [DOI: 10.1007/s00213-014-3794-9] - DOI - PubMed
Wouters 2017 {published data only}
    1. Wouters H, Scheper J, Koning H, Brouwer C, Twisk JW, Meer H, et al. Discontinuing inappropriate medication use in nursing home residents: a cluster randomized controlled trial. Annals of Internal Medicine 2017;167(9):609-17. [PMID: ] - PubMed
Yeh 2013 {published data only}
    1. Yeh YC, Liu CL, Peng LN, Lin MH, Chen LK. Potential benefits of reducing medication-related anticholinergic burden for demented older adults: a prospective cohort study. Geriatrics & Gerontology International 2013;13:694-700. [DOI: ] - PubMed

References to ongoing studies

Abebe 2021 {published data only}
    1. Abebe E, Campbell NL, Clark DO, Tu W, Hill JR, Harrington AB, et al. Reducing anticholinergic medication exposure among older adults using consumer technology: protocol for a randomized clinical trial. Research in Social & Administrative Pharmacy 2021;17(5):986-92. [DOI: 10.1016/j.sapharm.2020.10.010] - DOI - PMC - PubMed
Campbell 2022 {published data only}
    1. Campbell NL, Holden R, Gao S, Unverzagt F, Boustani M. R2D2: a cluster-randomized trial of deprescribing to support brain health. Epidemiology (Cambridge, Mass.) 2022;70(Suppl 1):S193.

Additional references

Boustani 2008
    1. Boustani M, Campbell N, Munger S, Maidment I, Fox C. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health 2008;4(3):311-20. [DOI: 10.2217/1745509X.4.3.311] - DOI
Carnahan 2004
    1. Carnahan RM, Lund BC, Perry PJ, Chrischilles EA. The concurrent use of anticholinergics and cholinesterase inhibitors: rare event or common practice? Journal of the American Geriatriatics Society 2004;52(12):2082-7. [DOI: 10.1111/j.1532-5415.2004.52563.x] - DOI - PubMed
Carnahan 2006
    1. Carnahan RM, Lund BC, Perry PJ, Pollock BG, Culp KR. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. Journal of Clinical Pharmacology 2006;46(12):1481-6. [DOI: 10.1177/0091270006292126] - DOI - PubMed
Comprehensive Meta‐Analysis Version 3 [Computer program]
    1. Comprehensive Meta-Analysis Version 3. Borenstein M, Hedges L, Higgins J, Rothstein H Biostat. Englewood: NJ, 2013.
Covidence [Computer program]
    1. Covidence. Version accessed prior to November 2023. Melbourne, Australia: Veritas Health Innovation. Available at www.covidence.org.
DSM 5
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th edition. Washington, DC: American Psychiatric Association, 2013.
Folstein 1975
    1. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 1975;12:189-98. - PubMed
Francis 1999
    1. Francis PT, Palmer AM, Snape M, Wilcock GK. The cholinergic hypothesis of Alzheimer’s disease: a review of progress. Journal of Neurology, Neurosurgery and Psychiatry 1999;66:137-47. - PMC - PubMed
GRADEpro GDT [Computer program]
    1. GRADEpro GDT. Hamilton (ON): McMaster University (developed by Evidence Prime). Available at gradepro.org.
Hampel 2018
    1. Hampel H, Mesulam MM, Cuello AC, Farlow MR, Giacobini E, Grossberg GT, et al. The cholinergic system in the pathophysiology and treatment of Alzheimer's disease. Brain 2018;141(7):1917-33. [DOI: 10.1093/brain/awy132] [PMID: ] - DOI - PMC - PubMed
Hanlon 2020
    1. Hanlon P, Quinn TJ, Gallacher KI, Myint PK, Jani BD, Nicholl BI, et al. Assessing risks of polypharmacy involving medications with anticholinergic properties. Annals of Family Medicine 2020;18(2):148-55. [DOI: 10.1370/afm.2501] - DOI - PMC - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-60. [DOI: 10.1136/bmj.327.7414.557] - DOI - PMC - PubMed
Higgins 2019
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane Handbook for Systematic Reviews of Interventions Version 6.0 (updated July 2019). Cochrane, 2019. Available from training.cochrane.org/handbook/archive/v6. - PMC - PubMed
Higgins 2022
    1. Higgins JP, Li T, Deeks JJ, editor(s). Chapter 6: Choosing effect measures and computing estimates of effect. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.3 (updated February 2022). Cochrane, 2022. Available from training.cochrane.org/handbook/archive/v6.3 2022.
Hilmer 2007
    1. Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to define the functional burden of medications in older people. Archives of Internal Medicine 2007;167(8):781-7. [DOI: 10.1001/archinte.167.8.781] - DOI - PubMed
Hoffmann 2014
    1. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014;348:g1678. [DOI: 10.1136/bmj.g1687] - DOI - PubMed
Kersten 2012
    1. Kersten H, Molden E, Tolo IK, Skovlund E, Engedal K, Wyller TB. Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: a randomized controlled trial. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2013;68(3):271-8. [DOI: 10.1093/gerona/gls176] - DOI - PubMed
Marzoughi 2021
    1. Marzoughi S, Banerjee A, Jutzeler CR, Prado MA, Rosner J, Cragg JJ, et al. Tardive neurotoxicity of anticholinergic drugs: a review. Journal of Neurochemistry 2021;158(6):1334-44. [DOI: 10.1111/jnc.15244] - DOI - PubMed
McKeith 2005
    1. McKeith IG, Dickson DW, Lowe J, Emre M, O'Brien JT, Feldman H, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology 2005;65:1863-72. - PubMed
McKhann 1984
    1. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-44. - PubMed
McKhann 2001
    1. McKhann GM, Albert MS, Grossman M, Miller B, Dickson D, Trojanowski JQ. Clinical and pathological diagnosis of frontotemporal dementia: report of the Work Group on Frontotemporal Dementia and Pick's Disease. Archives of Neurology 2001;58:1803-9. - PubMed
McKhann 2011
    1. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR Jr, Kawas CH, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer's & Dementia 2011;7:263-9. - PMC - PubMed
Nakham 2020
    1. Nakham A, Myint PK, Bond CM, Newlands R, Loke YK, Cruickshank M. Interventions to reduce anticholinergic burden in adults aged 65 and older: a systematic review. Journal of the American Medical Directors Association 2020;21(2):172-80. [DOI: 10.1016/j.jamda.2019.06.001] - DOI - PubMed
Nasreddine 2005
    1. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatric Society 2005;53:695-9. - PubMed
NICE 2023
    1. National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers. NICE, 2023. Available at www.nice.org.uk/guidance/ng97. - PubMed
Petersen 2001
    1. Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1133-42. - PubMed
Prince 2016
    1. Prince M, Comas-Herrera A, Knapp M, Guerchet M, Karagiannidou M. Improving healthcare for people living with dementia: coverage, quality and costs now and in the future. ADI, 2016. www.alzint.org/resource/world-alzheimer-report-2016/ (accessed prior to 27 April 2021).
Román 1993
    1. Román GC, Tatemichi TK, Erkinjutti T, Cummings JL, Masdeu JC, Garcia JH, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993;43:250-60. - PubMed
Sanghavi 2022
    1. Sanghavi R, Pana TA, Mamayusupova H, Maidment I, Fox C, Boekholdt SM, et al. Higher anticholinergic burden from medications is associated with significant increase in markers of inflammation in the EPIC-Norfolk prospective population-based cohort study. British Journal of Clinical Pharmacology 2022;88(7):3297-306. [DOI: 10.1111/bcp.15261] [PMID: ] - DOI - PMC - PubMed
Shawaqfeh 2022
    1. Shawaqfeh B, Hughes CM, McGuinness B, Barry HE. A systematic review of interventions to reduce anticholinergic burden in older people with dementia in primary care. International Journal of Geriatric Psychiatry 2022;37(6):Epub ahead of print. [PMID: ] - PMC - PubMed
Singh 2013
    1. Singh S, Loke YK, Enright P, Furberg CD. Pro-arrhythmic and pro-ischaemic effects of inhaled anticholinergic medications. Thorax 2013;68(1):114-6. [DOI: 10.1136/thoraxjnl-2011-201275] [PMID: ] - DOI - PubMed
Sterne 2019
    1. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:l4898. [DOI: 10.1136/bmj.l4898] - DOI - PubMed
Tan 2018
    1. Tan EC, Eriksdotter M, Garcia-Ptacek S, Fastbom J, Johnell K. Anticholinergic burden and risk of stroke and death in people with different types of dementia. Journal of Alzheimer's Disease 2018;65(2):589-96. [DOI: 10.3233/JAD-180353] [PMID: ] - DOI - PubMed
Taylor‐Rowan 2021
    1. Taylor-Rowan M, Edwards S, Noel-Storr AH, McCleery J, Myint PK, Soiza R, et al. Anticholinergic burden (prognostic factor) for prediction of dementia or cognitive decline in older adults with no known cognitive syndrome. Cochrane Database of Systematic Reviews 2021, Issue 5. Art. No: CD013540. [DOI: 10.1002/14651858.CD013540.pub2] - DOI - PMC - PubMed
Taylor‐Rowan 2022a
    1. Taylor-Rowan M, Kraia O, Kolliopoulou C, Cross AJ, Stewart C, Myint PK, et al. Anticholinergic burden for prediction of cognitive decline or neuropsychiatric symptoms in older adults with mild cognitive impairment or dementia. Cochrane Database of Systematic Reviews 2022, Issue 8. Art. No: CD015196. [DOI: 10.1002/14651858.CD015196.pub2] - DOI - PMC - PubMed
Van der Meer 2018
    1. Van der Meer HG, Wouter H, Pont LG, Taxis K. Reducing the anticholinergic and sedative load in older patients on polypharmacy by pharmacist-led medication review: a randomised controlled trial. BMJ Open 2018;8:e019042. [DOI: 10.1136/bmjopen-2017-019042] - DOI - PMC - PubMed
WHO 1993
    1. World Health Organization. International Classification of Diseases (ICD) (who.int). 7th edition. World Health Organization, 1993.

References to other published versions of this review

Taylor‐Rowan 2022b
    1. Taylor-Rowan M, Alharthi AA, Noel-Storr AH, Myint PK, Stewart C, McCleery J, et al. Anticholinergic deprescribing interventions for reducing risk of cognitive decline or dementia in older adults with and without prior cognitive impairment. Cochrane Database of Systematic Reviews 2022, Issue 12. Art. No: CD015405. [DOI: 10.1002/14651858.CD015405] - DOI - PMC - PubMed

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