Evidence map›Paper›PMID 25879993›Full record

SynthesisBMC geriatrics2015

Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review.

Mohammed Saji Salahudeen, Stephen B Duffull, Prasad S Nishtala

Registry-linked trialAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC geriatrics, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04360746 (The Influence of Clinical Pharmacist on the Quality of Drug Prescribing and Rehabilitation Outcomes in Post-acute Hip Fractured Patients), which is not on this map. Cited by 251 papers, 16 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
251citing papers in PubMed, 16 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04360746 nacompletednot on this mapstarted 2020, after this paper: background citation

The Influence of Clinical Pharmacist on the Quality of Drug Prescribing and Rehabilitation Outcomes in Post-acute Hip Fractured Patients

TypeinterventionalSponsorRabin Medical CenterRan2020 to 2022Enrolled200ConditionsHip Fractures, Clinical Pharmacists, Rehabilitation OutcomeArmsPharmaceutical intervention, Rehabilitation
3 · Its place in the literature

Who cites it

251 citing papers in PubMed, 16 syntheses or guidelines pooled it.

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191 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Mohammed Saji SalahudeenSchool of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. mohammed.salahudeen@otago.ac.nz.
Stephen B DuffullSchool of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. stephen.duffull@otago.ac.nz.
Prasad S NishtalaSchool of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. prasad.nishtala@otago.ac.nz.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe cumulative effect of taking multiple medicines with anticholinergic properties termed as anticholinergic burden can adversely impact cognition, physical function and increase the risk of mortality. Expert opinion derived risk scales are routinely used in research and clinical practice to quantify anticholinergic burden. These scales rank the anticholinergic activity of medicines into four categories, ranging from no anticholinergic activity (= 0) to definite/high anticholinergic activity (= 3). The aim of this systematic review was to compare anticholinergic burden quantified by the anticholinergic risk scales and evaluate associations with adverse outcomes in older people.

methodsWe conducted a literature search in Ovid MEDLINE, EMBASE and PsycINFO from 1984-2014 to identify expert opinion derived anticholinergic risk scales. In addition to this, a citation analysis was performed in Web of Science and Google Scholar to track prospective citing of references of selected articles for assessment of individual scales for adverse anticholinergic outcomes. The primary outcomes of interest were functional and cognitive outcomes associated with anticholinergic burden in older people. The critical appraisals of the included studies were performed by two independent reviewers and the data were extracted onto standardised forms.

resultsThe primary electronic literature search identified a total of 1250 records in the 3 different databases. On the basis of full-text analysis, we identified 7 expert-based anticholinergic rating scales that met the inclusion criteria. The rating of anticholinergic activity for medicines among these rating scales was inconsistent. For example, quetiapine was rated as having high anticholinergic activity in one scale (n = 1), moderate in another scale (n = 1) and low in two other scales (n = 2). Citation analysis of the individual scales showed that the Anticholinergic Cognitive Burden (ACB) scale was the most frequently validated expert based anticholinergic scale for adverse outcomes (N = 13).

conclusionsIn conclusion, there is not one standardised tool for measuring anticholinergic burden. Cohort studies have shown that higher anticholinergic burden is associated with negative brain effects, poorer cognitive and functional outcomes.

Indexed as

AgedAged, 80 and overBrainCholinergic AntagonistsCognitionCohort StudiesDrug-Related Side Effects and Adverse ReactionsHumansProspective StudiesRisk FactorsTreatment OutcomeCholinergic Antagonists

Identifiers

PMID25879993
PMCPMC4377853

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.