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Assessing the health implications of anticholinergic drugs in older people
In this narrative review, we analyzed the existing literature on the pros and cons of anticholinergic medications, focusing on their prevalence, underlying mechanisms, and methods of assessment. Our review underscores the significant adverse effects of anticholinergic drugs, particularly on cognition and functional abilities in older adults. These effects include the exacerbation of various cognitive states, increased psychiatric symptoms, heightened risk of delirium, functional decline, elevated hospitalization rates, greater likelihood of institutionalization, and increased mortality. While anticholinergic medications provide therapeutic benefits, their use in older adults requires careful evaluation due to these considerable risks. Discontinuation of anticholinergic therapy offers both benefits and challenges. We propose practical guidelines for their use in clinical contexts such as dementia, schizophrenia, depression, anxiety, Parkinson’s disease, cardiovascular conditions, and urinary incontinence.
Grossi CM, Richardson K, Savva GM, et al. Increasing prevalence of anticholinergic medication use in older people in England over 20 years: cognitive function and ageing study i and II. BMC Geriatr 2020;20:267.
DOI: https://doi.org/10.1186/s12877-020-01657-x
López-Álvarez J, Sevilla-Llewellyn-Jones J, Agüera-Ortiz L. Anticholinergic drugs in geriatric psychopharmacology. Front Neurosci 2019;13:1309.
DOI: https://doi.org/10.3389/fnins.2019.01309
Guo J, Huang X, Dou L, et al. Aging and aging-related diseases: from molecular mechanisms to interventions and treatments. Signal Transduct Target Ther 2022:7:391.
DOI: https://doi.org/10.1038/s41392-022-01251-0
Ismail Z, Ahmad WIW, Hamjah SH, Astina IK. The impact of population ageing: a review. Iran J Public Health 2021;50:2451-60.
DOI: https://doi.org/10.18502/ijph.v50i12.7927
Perrin F. On the origins of the demographic transition: rethinking the European marriage pattern. Cliometrica 2022;16:431-75.
DOI: https://doi.org/10.1007/s11698-021-00237-2
Niccoli T, Partridge L. Ageing as a risk factor for disease. Curr Biol 2012;22:R741-52.
DOI: https://doi.org/10.1016/j.cub.2012.07.024
Tartiere AG, Freije JMP, López-Otín C. The hallmarks of aging as a conceptual framework for health and longevity research. Front Aging 2024;5:1334261.
DOI: https://doi.org/10.3389/fragi.2024.1334261
Ferrucci L, Gonzalez-Freire M, Fabbri E, et al. Measuring biological aging in humans: a quest. Aging Cell 2020;19:e13080.
DOI: https://doi.org/10.1111/acel.13080
Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004;59:M255-63.
DOI: https://doi.org/10.1093/gerona/59.3.M255
Onder G, Vetrano DL, Palmer K, et al. Italian guidelines on management of persons with multimorbidity and polypharmacy. Aging Clin Exp Res 2022;34:989-96.
DOI: https://doi.org/10.1007/s40520-022-02094-z
Marengoni A, Angleman S, Melis R, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev 2011;10:430-9.
DOI: https://doi.org/10.1016/j.arr.2011.03.003
Carollo M, Boccardi V, Crisafulli S, et al. Medication review and deprescribing in different healthcare settings: a position statement from an Italian scientific consortium. Aging Clin Exp Res 2024;36:63.
DOI: https://doi.org/10.1007/s40520-023-02679-2
Coleman JJ, Pontefract SK. Adverse drug reactions. Clin Med 2016;16:481-5.
DOI: https://doi.org/10.7861/clinmedicine.16-5-481
Zazzara MB, Palmer K, Vetrano DLet al. Adverse drug reactions in older adults: a narrative review of the literature. Eur Geriatr Med 2021;12:463-73.
DOI: https://doi.org/10.1007/s41999-021-00481-9
Aronson JK, Ferner RE. Clarification of terminology in drug safety. Drug Saf 2005;28:851-70.
DOI: https://doi.org/10.2165/00002018-200528100-00003
Lau DT, Mercaldo ND, Harris AT, et al. Polypharmacy and potentially inappropriate medication use among community-dwelling elders with dementia. Alzheimer Dis Assoc Disord 2010;24:56-63.
DOI: https://doi.org/10.1097/WAD.0b013e31819d6ec9
Lau DT. Standing on the shoulders of Mark H. Beers: more than a giant in geriatric medicine. Clin Ther 31:822-4.
DOI: https://doi.org/10.1016/j.clinthera.2009.04.008
Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003;163:2716-24.
DOI: https://doi.org/10.1001/archinte.163.22.2716
Fick D, Semla T, Beizer J, et al. American Geriatrics Society Updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012;60:616-31.
DOI: https://doi.org/10.1111/j.1532-5415.2012.03923.x
Hanlon JT, Schmader KE, Samsa GP, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol 1992;45:1045-51.
DOI: https://doi.org/10.1016/0895-4356(92)90144-C
Schmader K, Hanlon JT, Weinberger M, et al. Appropriateness of medication prescribing in ambulatory elderly patients. J Am Geriatr Soc 1994;42:1241-7.
DOI: https://doi.org/10.1111/j.1532-5415.1994.tb06504.x
Perpétuo C, Plácido AI, Rodrigues D, et al. Prescription of potentially inappropriate medication in older inpatients of an internal medicine ward: concordance and overlap among the EU(7)-PIM list and Beers and STOPP criteria. Front Pharmacol 2021;12:676020.
DOI: https://doi.org/10.3389/fphar.2021.676020
Rodrigues DA, Plácido AI, Mateos-Campos R, et al. Effectiveness of interventions to reduce potentially inappropriate medication in older patients: a systematic review. Front Pharmacol 2022;12:777655.
DOI: https://doi.org/10.3389/fphar.2021.777655
Katzenschlager R, Sampaio C, Costa J, Lees A. Anticholinergics for symptomatic management of Parkinson´s disease. Cochrane Database Syst Rev 2003;2002:CD003735.
DOI: https://doi.org/10.1002/14651858.CD003735
Chew ML, Mulsant BH, Pollock BG, et al. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 2008;56:1333-41.
DOI: https://doi.org/10.1111/j.1532-5415.2008.01737.x
Cancelli I, Gigli GL, Piani A, et al. Drugs with anticholinergic properties as a risk factor for cognitive impairment in elderly people: a population-based study. J Clin Psychopharmacol 2008;28:654-9.
DOI: https://doi.org/10.1097/JCP.0b013e31818ce849
Pieper NT, Grossi CM, Chan WY, et al. Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis. Age Ageing 2020;49:939-47.
DOI: https://doi.org/10.1093/ageing/afaa090
Duboisa B, Padovanib A, Scheltensc P, et al. Timely diagnosis for Alzheimer’s disease: a literature review on benefits and challenges. J Alzheimers Dis 2016;49:617-31.
DOI: https://doi.org/10.3233/JAD-150692
Abdelnour C, Agosta F, Bozzali M, et al. Perspectives and challenges in patient stratification in Alzheimer’s disease. Alzheimers Res Ther 2022;14:112.
DOI: https://doi.org/10.1186/s13195-022-01055-y
Bottiggi KA, Salazar JC, Yu L, et al. Lone-term cognitive impact of anticholinergic medications in older adults. Am J Geriatr Psychiatry 2006;14:980-4.
DOI: https://doi.org/10.1097/01.JGP.0000224619.87681.71
Fox C, Richardson K, Maidment ID, et al. Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. J Am Geriatr Soc 2011;59:1477-83.
DOI: https://doi.org/10.1111/j.1532-5415.2011.03491.x
Jamsen KM, Gnjidic D, Hilmer SN, et al. Drug burden index and change in cognition over time in community-dwelling older men: the CHAMP study. Ann Med 2017;49:157-64.
DOI: https://doi.org/10.1080/07853890.2016.1252053
Cai X, Campbell N, Khan B, et al. Long-term anticholinergic use and the aging brain. Alzheimers Dement 2013;9:377-85.
DOI: https://doi.org/10.1016/j.jalz.2012.02.005
Campbell NL, Lane KA, Gao S, et al. Anticholinergics influence transition from normal cognition to mild cognitive impairment in older adults in primary care. Pharmacotherapy 2018;38:511-9.
DOI: https://doi.org/10.1002/phar.2106
Pomara N, Willoughby LM, Wesnes K, Sidtis JJ. Increased anticholinergic challenge-induced memory impairment associated with the APOE-ɛ4 allele in the elderly: a controlled pilot study. Neuropsychopharmacology 2004;29:403-9.
DOI: https://doi.org/10.1038/sj.npp.1300305
Gray SL, Anderson ML, Dublin S, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med 2015;175:401-7.
DOI: https://doi.org/10.1001/jamainternmed.2014.7663
Smithard DG, Fox C, Maidment ID, et al. Do anticholinergic drugs contribute to functional and cognitive decline? Aging health 2012;8:57-60.
DOI: https://doi.org/10.2217/ahe.11.87
Boccardi V, Baroni M, Paolacci L, et al. Anticholinergic burden and functional status in older people with cognitive impairment: results from the ReGAl project. J Nutr Health Aging 2017;21:389-96.
DOI: https://doi.org/10.1007/s12603-016-0787-x
Bostock CV, Soiza RL, Mangoni AA. Associations between different measures of anticholinergic drug exposure and Barthel Index in older hospitalized patients. Ther Adv Drug Saf 2013;4:235-45.
DOI: https://doi.org/10.1177/2042098613500689
Lowry E, Woodman RJ, Soiza RL, Mangoni AA. Associations between the anticholinergic risk scale score and physical function: potential implications for adverse outcomes in older hospitalized patients. J Am Med Dir Assoc 2011;12:565-72.
DOI: https://doi.org/10.1016/j.jamda.2011.03.006
Phutietsile GO, Fotaki N, Jamieson HA, Nishtala PS. The association between anticholinergic burden and mobility: a systematic review and meta-analyses. BMC Geriatr 2023;23:161.
DOI: https://doi.org/10.1186/s12877-023-03820-6
Marcum ZA, Perera S, Thorpe JM, et al. Anticholinergic use and recurrent falls in community-dwelling older adults. Ann Pharmacother 2015;49:1214-21.
DOI: https://doi.org/10.1177/1060028015596998
How to Cite
Boccardi, M., & Boccardi, V. (2025). Assessing the health implications of anticholinergic drugs in older people. Geriatric Care, 11. https://doi.org/10.4081/gc.2025.13311
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