Salahudeen Mohammed Saji, Duffull Stephen B, Nishtala Prasad S
School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
Drugs Aging. 2014 Mar;31(3):185-92. doi: 10.1007/s40266-014-0158-4.
Medicines with anticholinergic properties increase the risks of functional and cognitive decline, morbidity and mortality, institutionalization and length of hospital stay in older people. It is postulated that minimizing anticholinergic burden should result in improved short-term memory, confusion and delirium, and may improve the quality of life and daily functioning of older people.
The objective of this systematic review was to investigate the impact of discontinuing medicines with anticholinergic properties on cognitive outcomes in older people.
A comprehensive systematic search was performed to identify relevant studies, using Medline, Embase, International Pharmaceutical Abstracts (IPA), PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Central Register of Controlled Trials, from 1946 to July 2013. The critical appraisal was performed by two independent reviewers, and the data were extracted onto standardized forms. The primary outcome of interest was evaluation of cognitive changes in older people after anticholinergic discontinuation, measured using cognitive assessment scales. Meta-analysis was not conducted, because of the heterogeneity of the study designs, interventions and outcome measures.
The primary electronic literature search identified a total of 475 records in the six different databases. On the basis of full-text analysis, only four studies met the inclusion criteria. The review found two randomized control trials and two prospective cohort studies that met the inclusion criteria. Only the cohort studies demonstrated improvement of cognitive performance after discontinuation of anticholinergic medicines.
The impact of anticholinergic discontinuation on cognitive function remains poorly researched and poorly understood. A larger sample size, longer duration of follow-up and better methods of assessing anticholinergic-induced cognitive impairment are warranted.
具有抗胆碱能特性的药物会增加老年人功能和认知能力下降、发病和死亡、入住养老院以及住院时间延长的风险。据推测，将抗胆碱能负担降至最低应能改善短期记忆、意识混乱和谵妄，并可能提高老年人的生活质量和日常功能。
本系统评价的目的是研究停用具有抗胆碱能特性的药物对老年人认知结局的影响。
进行全面的系统检索以识别相关研究，检索了1946年至2013年7月期间的Medline、Embase、国际药学文摘（IPA）、心理学文摘（PsycINFO）、护理及相关健康文献累积索引（CINAHL）和Cochrane对照试验中心注册库。由两名独立的评审员进行批判性评价，并将数据提取到标准化表格中。感兴趣的主要结局是使用认知评估量表测量老年人停用抗胆碱能药物后的认知变化。由于研究设计、干预措施和结局测量的异质性，未进行荟萃分析。
初步电子文献检索在六个不同数据库中总共识别出475条记录。基于全文分析，只有四项研究符合纳入标准。该评价发现两项随机对照试验和两项前瞻性队列研究符合纳入标准。只有队列研究表明停用抗胆碱能药物后认知表现有所改善。
停用抗胆碱能药物对认知功能的影响仍研究不足且了解甚少。需要更大的样本量、更长的随访时间以及更好的评估抗胆碱能引起的认知障碍的方法。
