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Anticholinergic Drug Burden and Delirium: A Systematic Review.
J Am Med Dir Assoc. 2021 01; 22(1):65-73.e4.JA

Abstract

OBJECTIVES

To investigate the association between anticholinergic drug burden (ADB), measured with anticholinergic drug scales, and delirium and delirium severity.

DESIGN

Systematic review.

SETTING AND PARTICIPANTS

All available studies.

METHODS

A systematic literature search was performed in Medline, Embase, PsycINFO, Web of Science, CINAHL, Cochrane library, and Google Scholar. Studies evaluating the association between ADB (measured as a total score) and delirium or delirium severity, published in English, were eligible for inclusion.

RESULTS

Sixteen studies, including 148,756 persons, were included. Fifteen studies investigated delirium. ADB was measured with the Anticholinergic Risk Scale (ARS, n = 5), the Anticholinergic Cognitive Burden Scale (ACB, n = 6), the list of Chew (n = 1), the Anticholinergic Drug Scale (ADS, n = 5), a modified version of the ARS (n = 1), and a modified version of the ACB (n = 1). A high ADB, measured with the ARS, was associated with delirium (5/5). Also with the modified version of the ARS and ACB, an association was found between a high ADB and delirium during 3-month (1/1) and 1-year follow-up (1/1), respectively. When ADB was assessed with other scales, the results were inconclusive, with only 1 positive association for the ACB (1/6) and ADS (1/5) each. The possible association between ADB and delirium severity has also been investigated (ADS n = 2, Summers Drug Risk Number n = 1). One study found an association between a high ADB, measured with the ADS, and an increase in severity of delirium.

CONCLUSIONS AND IMPLICATIONS

ADB assessed with the ARS is consistently associated with delirium. The association found between the modified versions of the ARS and ACB and delirium needs confirmation. When ADB was assessed with other scales, the findings were inconclusive. The current findings suggest that the ARS might be a useful tool to identify patients at increased risk for delirium.

Authors+Show Affiliations

Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Hospital Pharmacy, Franciscus Gasthuis and Vlietland, Rotterdam and Schiedam, the Netherlands. Electronic address: a.egberts@erasmusmc.nl.Section of Geriatric Medicine, Department of Internal Medicine, Bellvitge University Hospital, Barcelona, Spain.Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

32703688

Citation

Egberts, Angelique, et al. "Anticholinergic Drug Burden and Delirium: a Systematic Review." Journal of the American Medical Directors Association, vol. 22, no. 1, 2021, pp. 65-73.e4.
Egberts A, Moreno-Gonzalez R, Alan H, et al. Anticholinergic Drug Burden and Delirium: A Systematic Review. J Am Med Dir Assoc. 2021;22(1):65-73.e4.
Egberts, A., Moreno-Gonzalez, R., Alan, H., Ziere, G., & Mattace-Raso, F. U. S. (2021). Anticholinergic Drug Burden and Delirium: A Systematic Review. Journal of the American Medical Directors Association, 22(1), 65-e4. https://doi.org/10.1016/j.jamda.2020.04.019
Egberts A, et al. Anticholinergic Drug Burden and Delirium: a Systematic Review. J Am Med Dir Assoc. 2021;22(1):65-73.e4. PubMed PMID: 32703688.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anticholinergic Drug Burden and Delirium: A Systematic Review. AU - Egberts,Angelique, AU - Moreno-Gonzalez,Rafael, AU - Alan,Hava, AU - Ziere,Gijsbertus, AU - Mattace-Raso,Francesco U S, Y1 - 2020/07/20/ PY - 2020/03/05/received PY - 2020/04/20/revised PY - 2020/04/22/accepted PY - 2020/7/25/pubmed PY - 2021/7/1/medline PY - 2020/7/25/entrez KW - Delirium KW - anticholinergic drug scoring systems KW - anticholinergic load SP - 65 EP - 73.e4 JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc VL - 22 IS - 1 N2 - OBJECTIVES: To investigate the association between anticholinergic drug burden (ADB), measured with anticholinergic drug scales, and delirium and delirium severity. DESIGN: Systematic review. SETTING AND PARTICIPANTS: All available studies. METHODS: A systematic literature search was performed in Medline, Embase, PsycINFO, Web of Science, CINAHL, Cochrane library, and Google Scholar. Studies evaluating the association between ADB (measured as a total score) and delirium or delirium severity, published in English, were eligible for inclusion. RESULTS: Sixteen studies, including 148,756 persons, were included. Fifteen studies investigated delirium. ADB was measured with the Anticholinergic Risk Scale (ARS, n = 5), the Anticholinergic Cognitive Burden Scale (ACB, n = 6), the list of Chew (n = 1), the Anticholinergic Drug Scale (ADS, n = 5), a modified version of the ARS (n = 1), and a modified version of the ACB (n = 1). A high ADB, measured with the ARS, was associated with delirium (5/5). Also with the modified version of the ARS and ACB, an association was found between a high ADB and delirium during 3-month (1/1) and 1-year follow-up (1/1), respectively. When ADB was assessed with other scales, the results were inconclusive, with only 1 positive association for the ACB (1/6) and ADS (1/5) each. The possible association between ADB and delirium severity has also been investigated (ADS n = 2, Summers Drug Risk Number n = 1). One study found an association between a high ADB, measured with the ADS, and an increase in severity of delirium. CONCLUSIONS AND IMPLICATIONS: ADB assessed with the ARS is consistently associated with delirium. The association found between the modified versions of the ARS and ACB and delirium needs confirmation. When ADB was assessed with other scales, the findings were inconclusive. The current findings suggest that the ARS might be a useful tool to identify patients at increased risk for delirium. SN - 1538-9375 UR - https://www.unboundmedicine.com/medline/citation/32703688/Anticholinergic_Drug_Burden_and_Delirium:_A_Systematic_Review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-8610(20)30349-2 DB - PRIME DP - Unbound Medicine ER -