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Meta-Analysis
. 2015 Aug;80(2):209-20.
doi: 10.1111/bcp.12617. Epub 2015 May 20.

Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis

Kimberley Ruxton  1 , Richard J Woodman  2 , Arduino A Mangoni  1
Affiliations
Meta-Analysis

Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis

Kimberley Ruxton et al. Br J Clin Pharmacol. 2015 Aug.

Erratum in

  • Br J Clin Pharmacol. 2015 Oct;80(4):921-6

Abstract

Aim: The aim was to investigate associations between drugs with anticholinergic effects (DACEs) and cognitive impairment, falls and all-cause mortality in older adults.

Methods: A literature search using CINAHL, Cochrane Library, Embase and PubMed databases was conducted for randomized controlled trials, prospective and retrospective cohort and case-control studies examining the use of DACEs in subjects ≥65 years with outcomes on falls, cognitive impairment and all-cause mortality. Retrieved articles were published on or before June 2013. Anticholinergic exposure was investigated using drug class, DACE scoring systems (anticholinergic cognitive burden scale, ACB; anticholinergic drug scale, ADS; anticholinergic risk scale, ARS; anticholinergic component of the drug burden index, DBIAC ) or assessment of individual DACEs. Meta-analyses were performed to pool the results from individual studies.

Results: Eighteen studies fulfilled the inclusion criteria (total 124 286 participants). Exposure to DACEs as a class was associated with increased odds of cognitive impairment (OR 1.45, 95% CI 1.16, 1.73). Olanzapine and trazodone were associated with increased odds and risk of falls (OR 2.16, 95% CI 1.05, 4.44; RR 1.79, 95% CI 1.60, 1.97, respectively), but amitriptyline, paroxetine and risperidone were not (RR 1.73, 95% CI 0.81, 2.65; RR 1.80, 95% CI 0.81, 2.79; RR 1.39, 95% CI 0.59, 3.26, respectively). A unit increase in the ACB scale was associated with a doubling in odds of all-cause mortality (OR 2.06, 95% CI 1.82, 2.33) but there were no associations with the DBIAC (OR 0.88, 95% CI 0.55, 1.42) or the ARS (OR 3.56, 95% CI 0.29, 43.27).

Conclusions: Certain individual DACEs or increased overall DACE exposure may increase the risks of cognitive impairment, falls and all-cause mortality in older adults.

Keywords: all-cause mortality; cognitive impairment; drugs with anticholinergic effects; falls; older adults; risk scoring systems.

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Figures

Figure 1
Figure 1
PRISMA study selection flow diagram
Figure 2
Figure 2
Forest plot of odds ratios of cognitive impairment with the use of drugs with anticholinergic effects as a class (dashed line indicates line of no effect). OR: odds ratio of an event in those exposed to drugs with anticholinergic effects compared to the control exposure; CI confidence interval
Figure 3
Figure 3
Forest plot of risk estimates (odds ratio or relative risk) of falls with the use of individual drugs with anticholinergic effects (dashed line indicates line of no effect). CI: confidence interval; a: random effects analysis; b: analysis using odds ratio (OR). The odds ratio or relative risk refers to the odds or risk of an event in those exposed to drugs with anticholinergic effects compared with the control exposure
Figure 4
Figure 4
Forest plot of odds ratios of all-cause mortality with drugs with anticholinergic effect scoring systems (dashed line indicates line of no effect). OR: odds ratio; CI: confidence interval; a: random effects analysis; ACB Scale: Anticholinergic Cognitive Burden Scale; ARS Score: Anticholinergic Risk Scale Score; DBI Score: Drug Burden Index (anticholinergic component) Score. The odds ratio refers to the odds of an event in those exposed to drugs with anticholinergic effects compared with the control exposure
See this image and copyright information in PMC

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