In a systemic review of more than a decade of studies on the
effects of drugs with anticholinergic properties, they report that these drugs have
a significant adverse effect on both cognitive and physical functioning,
including the ability to feed and dress oneself.
Anticholinergic medications affect the brain by blocking
acetylcholine, a nervous system neurotransmitter. They are sold over the
counter as sleep aids and bladder leakage preventives and prescribed for many diseases
including hypertension and congestive heart failure.
The review found that these 46 studies, which followed 60,944 patients,
showed only limited evidence of a connection between anticholinergics and
delirium, a short-term decline in cognition. Additionally the review indicated
that the studies did not demonstrate a strong tie between medications with
anticholinergic properties and death. According to Regenstrief Institute
investigator Noll Campbell, Pharm.D., senior author of the review paper, this
may be because most studies were insufficient in length to reveal a significant
link between the medications and death.
This is the first systematic review to assess the effects of medications
with anticholinergic properties on physical function and delirium. The authors
say it also provides an important update on cognitive function and mortality.
"Anticholinergics, both over-the-counter and prescription
medications, impact the lives of older adults in ways doctors, patients and
their families may not realize," said Dr. Campbell, who is also a research
assistant professor in the Purdue University College of Pharmacy. "I don't
see use of these medications declining. Doctors and patients are familiar with
these drugs and unfortunately are far less familiar with equally effective
alternatives."
For example, Dr. Campbell advised, rather than taking sleeping
pills with anticholinergic properties, one could refrain from napping, limit evening
exercise and remove distractions from the bedroom. Institutions like hospitals
and nursing homes could work to keep older adults awake and stimulated during
the day, naturally encouraging nighttime slumber.
Dr. Campbell and colleagues from the Regenstrief Institute and
the IU Center for Aging Research are working to identify diagnosis- and patient-dependent
alternatives to exposure to anticholinergic medications as well as methods to
inform physicians of their advisability via prompts within electronic medical
record systems.
"Significant ongoing concerns remain about these
medicines, and this review paper for the first time in one place has
highlighted the impact on function as well as memory and death," said
Chris Fox, M.D., of the University of East Anglia, the review paper's first
author. Dr. Fox is a psychiatrist. In 2011, he and Regenstrief and IU Center
for Aging Research collaborators published the results of a study of 13,000 men
and women age 65 and older in which they found a link between anticholinergic
medications and death.
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