ArticleEuropean journal of clinical pharmacology2021
Anticholinergic load and delirium in end-of-life patients.
Article in European journal of clinical pharmacology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Risk Factors for Delirium in the Palliative Care Population: A Systematic Review and Meta-Analysis.Frontiers in psychiatry · 2021Pooled it
- Cumulative Anticholinergic Burden and Risk of Delirium Among Older Adults with Alzheimer's Disease.Pharmacy (Basel, Switzerland) · 2026Article
- Effect of Anticholinergic Drug Burden on Postoperative Delirium in Elderly Patients: A Nested Case-Control Study.CNS neuroscience & therapeutics · 2026Article
- Imminent Respiratory Collapse in Advanced Head and Neck Cancer: A Case Report and Discussion.Palliative medicine reports · 2025Article
- Anticholinergic Burden and Cognitive Impairment in Nursing Homes: A Comparison of Four Anticholinergic Scales.Drugs & aging · 2023Article
- Perspectives on deprescribing in palliative care.Expert review of clinical pharmacology · 2023Review
- Prevalence of Delirium in End-of-Life Palliative Care Patients: An Observational Study.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2022Observational
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDelirium is a neuropsychiatric syndrome associated with negative outcomes, including worsening of cognitive and functional status and an increased burden on patients and caregivers. Medications with anticholinergic effect have been associated with delirium symptoms, but the relationship is still debated.
objectiveTo assess the relation between delirium and anticholinergic load according to the hypothesis that the cumulative anticholinergic burden increases the risk of delirium.
methodsThis retrospective cross-sectional study was conducted in a sample of end-of-life patients in a hospice or living at home between February and August 2019. Delirium was diagnosed on admission using the 4 'A's Test (4AT) and each patient's anticholinergic burden was measured with the Anticholinergic Cognitive Burden (ACB) scale.
resultsOf the 461 eligible for analysis, 124 (26.9%) had delirium. Anticholinergic medications were associated with an increased risk of delirium in univariate (OR (95% CI) 1.26 (1.16-1.38), p < 0.0001) and multivariate models adjusted for age, sex, dementia, tumors, Karnofsky Performance Status (KPS) score, days of palliative assistance, and setting (OR (95% CI) 1.16 (1.05-1.28), p < 0.0001). Patients with delirium had a greater anticholinergic burden than those without, with a dose-effect relationship between total ACB score and delirium. Patients who scored 4 or more had 2 or 3 times the risk of delirium than those not taking anticholinergic drugs. The dose-response relationship was maintained in the multivariate model.
conclusionsAnticholinergic drugs may influence the development of delirium due to the cumulative effect of multiple medications with modest antimuscarinic activity.
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