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European Journal of Clinical Pharmacology

, Volume 75, Issue 12, pp 1631–1644 | Cite as

Association between anticholinergic (atropinic) drug exposure and cognitive function in longitudinal studies among individuals over 50 years old: a systematic review

  • Laurine AndreEmail author
  • Adeline Gallini
  • François Montastruc
  • Jean-Louis Montastruc
  • Antoine Piau
  • Maryse Lapeyre-Mestre
  • Virginie Gardette
Review

Abstract

Purpose

With increasing age, adults are often exposed to anticholinergic drugs and are prone to potential adverse drug reaction, among which cognitive impairment. If the short-term cognitive effects of anticholinergic drugs are well established, their long-term cognitive effects have less been studied.

Objective

To provide a systematic review of longitudinal studies which assessed the effect of anticholinergic exposure on cognition in individuals over 50 years.

Materials

We searched the MEDLINE database for studies with a minimal 6-month follow-up, assessing anticholinergic exposure through a biological measure or a clinical list and reporting at least one cognitive outcome. We used the modified Newcastle-Ottawa scale and additional criteria regarding the anticholinergic exposure to assess studies’ methodological quality. Given the heterogeneity of the studies, we performed a systematic review.

Results

Among the 1574 references retrieved, 25 studies were included. Anticholinergic medications were mostly defined through the Anticholinergic Cognitive Burden Scale (n = 14/25). Six studies evaluated baseline drug collection, 14 used longitudinal aggregated measure, and 5 multiple drug exposure measures over time. Seventeen studies assessed anticholinergic burden. Cognitive function was assessed by mild cognitive impairment/dementia incidence (n = 15) or neuropsychological tests (n = 14). Most studies were of poor quality and retrieved discordant results. However, studies with good quality (n = 4) suggested a relationship between anticholinergic drug exposure and/or burden and cognitive function.

Conclusion

Our review suggests a deleterious effect of anticholinergic exposure on mid/long-term cognitive function but should be confirmed in studies with improved methodology. Meanwhile, prescription of anticholinergic drugs should remain cautious.

Keywords

Anticholinergic drug exposure  Anticholinergic burden  Cognitive decline  Longitudinal study Systematic review 

Notes

Acknowledgements

The authors would like to thank Dr. Anne-Bahia Abdeljalil for her writing assistance.

Authors’ contribution

All authors contributed to the writing of the manuscript and approved the final version.

Compliance with ethical standards

Conflict of interest

Andre Laurine, Gallini Adeline, Montastruc François, Montastruc Jean-Louis, Piau Antoine, Lapeyre-Mestre Maryse, and Gardette Virginie have no conflicts of interest directly relevant to the content of this study.

Supplementary material

228_2019_2744_MOESM1_ESM.docx (104 kb)
ESM 1 (DOCX 104 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.UMR INSERM 1027, Université de ToulouseCentre Hospitalo-Universitaire de Toulouse (CHU Toulouse)ToulouseFrance
  2. 2.Service d’EpidémiologieCentre Hospitalo-Universitaire de Toulouse (CHU Toulouse)ToulouseFrance
  3. 3.Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, Pharmacoépidémiologie et d’Informations sur le MédicamentCentre Hospitalo-Universitaire de Toulouse (CHU Toulouse)ToulouseFrance
  4. 4.Gérontopôle de Toulouse, Institut du VieillissementCentre Hospitalo-Universitaire de Toulouse (CHU Toulouse)ToulouseFrance

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