Anticholinergic Drug Burden and Delirium: A Systematic Review

Angelique Egberts, R Moreno-Gonzalez, Hava Alan, Bert Ziere, F.U.S. Mattace Raso

Research output: Contribution to journalReview articleAcademicpeer-review

49 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)65-73.e4
JournalJournal of the American Medical Directors Association
Issue number1
Publication statusPublished - 1 Jan 2021

Bibliographical note

Funding Information:
We thank Wichor Bramer and Sabrina Meertens-Gunput, biomedical information specialists from the Medical Library of the Erasmus MC University Medical Center, for their assistance with the electronic literature search.

Publisher Copyright:
© 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine

Research programs

  • EMC OR-01


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