ArticleSchizophrenia research2017
Cognitive burden of anticholinergic medications in psychotic disorders.
Article in Schizophrenia research, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 4 of them syntheses that pooled it.
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Who cites it
51 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Cholinergic system in schizophrenia: A systematic review and meta-analysis.Molecular psychiatry · 2025Pooled it
- Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review.European journal of clinical pharmacology · 2021Pooled it
- Anticholinergic Burden and Cognitive Performance in Patients With Schizophrenia: A Systematic Literature Review.Frontiers in psychiatry · 2021Pooled it
- [Schizophrenia and bipolar disorder : Treatment of cognitive impairments].Der Nervenarzt · 2018Pooled it
- Verbal learning deficits associated with increased anticholinergic burden are attenuated with targeted cognitive training in treatment refractory schizophrenia patients.Schizophrenia research · 2019Trial
- Cumulative anticholinergic burden is associated with lower clozapine metabolic ratios: a cross-sectional study.BMC psychiatry · 2026Article
- Long-term benzodiazepine use is associated with poorer cognitive function in schizophrenia: findings from the SALT-C cohort.BMC psychiatry · 2026Observational
- Nationwide trends in psychiatric prescription practices for drugs with putative cognitive adverse effects in schizophrenia spectrum and bipolar disorders from 2013 to 2022.Journal of pharmaceutical policy and practice · 2026Article
- Memory in Psychiatric Disorders: A Review.Life (Basel, Switzerland) · 2025Review
- Neural fingerprints of data driven cognitive subtypes across the psychosis spectrum: a B-SNIP study.Translational psychiatry · 2025Article
- Guideline for pharmacological treatment of schizophrenia 2022.Neuropsychopharmacology reports · 2025Article
- Impact of Anticholinergic Burden on Cognitive Functions in Individuals with Bipolar Disorder, Schizoaffective Disorder, and Schizophrenia.Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology · 2025Article
- Article
- Treatment of Cognitive Impairment Associated with Schizophrenia Spectrum Disorders: New Evidence, Challenges, and Future Perspectives.Brain sciences · 2024Review
- Comparative analysis of anticholinergic burden scales to explain iatrogenic cognitive impairment in schizophrenia: results from the multicenter FACE-SZ cohort.Frontiers in pharmacology · 2024Article
- Definition, assessment and treatment of cognitive impairment associated with schizophrenia: expert opinion and practical recommendations.Frontiers in psychiatry · 2024Review
- Pharmacological Treatment of Cognitive Impairment Associated With Schizophrenia: State of the Art and Future Perspectives.Schizophrenia bulletin open · 2024Article
- Effects of Anticholinergic Burden on Verbal Memory Performance in First-Episode Psychosis.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2023Article
- Basal-Forebrain Cholinergic Nuclei Alterations are Associated With Medication and Cognitive Deficits Across the Schizophrenia Spectrum.Schizophrenia bulletin · 2023Article
- Cross-diagnostic determinants of cognitive functioning: the muscarinic cholinergic receptor as a model system.Translational psychiatry · 2023Review
Corrections and comments
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Authors and funding
15 authors.
Funding
Abstract
backgroundPatients with psychotic disorders are often treated with numerous medications, many of which have anticholinergic activity. We assessed cognition in relation to the cumulative anticholinergic burden of multiple drugs included in treatment regimens of participants from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) study.
methodClinically stable participants with schizophrenia (n=206), schizoaffective disorder (n=131), and psychotic bipolar disorder (n=146) were examined. Anticholinergic properties of all scheduled drugs were quantified using the Anticholinergic Drug Scale (ADS). ADS scores were summed across individual drugs to create a total ADS burden score for each participant and examined in relation to the Brief Assessment of Cognition in Schizophrenia (BACS).
resultsAnticholinergic burden aggregated across all medications was inversely related to cognitive performance starting at ADS scores of 4 in participants with schizophrenia. Those with ADS scores ≥4 had lower composite BACS scores compared to those with ADS<4 (p=0.004). Among BACS subtests, Verbal Memory was the most adversely affected by high anticholinergic burden. Despite similar anticholinergic burden scores across groups, a significant threshold effect of anticholinergic burden was not detected in schizoaffective or psychotic bipolar disorder.
conclusionWe identified an adverse effect threshold of anticholinergic burden on cognition in clinically stable participants with schizophrenia. This relationship was not identified in affective psychoses. Examination of other medications, doses, and clinical measures did not account for these findings. Patients with schizophrenia may have increased cognitive susceptibility to anticholinergic medications and the aggregate effects of one's medication regimen may be important to consider in clinical practice.
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