Table 1.
Included Study Characteristics
| Study | Design | Setting/Data source | Accrual period | Sample size | Anticholinergic exposure | Inclusion criteria (Exclusion criteria) | Follow-up |
|---|---|---|---|---|---|---|---|
| Berdot et al. 2009 | Prospective cohort | Bordeaux, Dijon, Montpellier (France); The 3C cohort study | 1999–2000 | 6343 | AC drug class | Aged ≥65 years, non-institutionalised, living in either cities, registered with electoral roll. | 2 and 4 years |
| Campbell et al. 2010 | Prospective cohort | Indianapolis-Ibadan Dementia Project (IIDP) cohort | 2001 | 1652 | AC drug class | African Americans aged ≥70 years, enrolled in IIDP between 2001–2007, normal cognitive function at baseline. (Dementia, cognitive impairment no dementia, or poor screening performance at baseline) | 3 and 6 years |
| Carriere et al. 2009 | Prospective cohort | Bordeaux, Dijon, Montpellier (France); The 3C cohort study | 1999–2001 | 6912 | AC drug class | Aged ≥65 years, non-institutionalised. (Dementia) | 2 and 4 years |
| Coupland et al. 2011 | Retrospective cohort | UK QResearch primary care database. General practices | 1996–2007 | 60 746 | Amitriptyline; Mirtazapine; Paroxetine; Trazodone | Aged ≥65–100 years, medical record diagnosis of depression, diagnosis made at ≥65 years, diagnosis was recorded between 1/01/1996–31/12/2007, identified using QResearch primary care database. (Temporary residents, previous diagnosis of depression in the 12-month period prior to their index-recorded, prescribed antidepressants in the 12-month period prior to recorded depression diagnosis, diagnosis of schizophrenia, bipolar disorder or other types of psychoses) | N/A |
| Fox et al. 2011 | Prospective cohort | England and Wales, UK. Medical Research Council Cognitive Function and Ageing study (MRC CFAS) | 1991–1993 | 12 250 | ACB scale | Aged ≥65 years, living in the community and institutions | 2 years |
| Hien et al. 2005 | Prospective cohort | Sydney, Australia. Fracture Risk Epidemiology in the Elderly study | 1999–2003 | 2005 | Olanzapine; Risperidone | ≥ 65 years, living in nursing homes and hostels | 1 month |
| Hoffmann et al. 2003 | Randomised control trial | N/A | N/A | 494 | Olanzapine; Risperidone | ≥ 65 years, living in the community. | N/A |
| Lackner et al. 2008 | Randomised control trial | Minnesota, USA. Nursing homes | 2003–2005 | 50 | Oxybutynin | Female, Aged ≥65, Resident for ≥3 months in long-stay nursing home unit, MMSE score of 5–23, Global Deterioration Scale score of 3–6, urinary incontinence, ≥1 symptom or sign of urge urinary incontinence; nocturia or nocturnal enuresis >2 times per night; staff observation that incontinence occurs on way to toilet or resident reports urgency; or medical record documentation of detrusor overactivity or urgency, Ability to swallow medication intact, Medication adherence rate ≥ 80% during the week before screening. (Terminal illness, bed-bound, non-communicative, delirium, Lewy body dementia, history of ≥3 UTI’s in previous year or current infection, post-void residual urine volume ≥ 150 mL, urethral diverticulum, bladder tumor or stone, severe pelvic organ prolapse or vaginitis, genitourinary surgery within past 6 months, hepatic disease, severe cardiovascular disease, myasthenia gravis, spinal cord injury, bowel movement < every 3 days, history of GI obstruction or decreased motility, current drug therapy for urinary incontinence, Current use of acetylcholinesterase inhibitor or bisphosphonate, investigational drug, systemic or ophthalmic cholinomimetic drug, diphenhydramine, or gastrointestinal antispasmodic within 2 weeks before trial). | 1 month |
| Lowry et al. 2011 | Prospective cohort | Aberdeen NHS Grampians, Scotland. Geriatric wards | 2010 | 362 | ARS scale | Aged ≥60 years, living in the community and institutions. (Opt-out basis). | N/A |
| Lowry et al. 2012 | Prospective cohort | Aberdeen NHS Grampians, Scotland. Geriatric wards | 2010 | 362 | DBI (AC) | Aged ≥60 years, living in the community and institutions. (Opt-out basis). | 6.5 months |
| Luukkanen et al. 2011 | Retrospective cohort | Helsinki, Finland | 1999–2000 | 425 | AC drug class | Aged ≥70 years. (Coma). | 2 years |
| Mangoni et al. 2013 | Prospective cohort | Amsterdam, Netherlands. Academic Medical Centre | 2005–2008 | 71 | ACB scale; ADS; ARS; DBI (AC) | Aged ≥65–100 years, admitted with hip fracture and scheduled for surgery. (No informed consent, no blood withdrawal for SAA, no SAA before surgery). | 1 year |
| Marras et al. 2012 | Case–control | Ontario, Canada. Ontario drug benefit database | 2002–2007 | 31 328 | Quetiapine | Aged ≥70 years, Parkinson’s disease. (Dispensed any antipsychotic drug in the year prior to cohort entry, prior diagnoses of primary psychiatric disorders requiring treatment with antipsychotics, diagnostic codes for brain tumour or pituitary disorders in the preceding 5 years, receiving palliative care services in the 6 months prior to cohort entry). | 1 month |
| Panula et al. 2009 | Retrospective cohort | Satakunta province, Western Finland | 1999–2000 | 461 | AC drug class | Aged ≥65 years, admitted with hip fracture and scheduled for surgery. (Non-residents undergoing hip fracture surgery in study area). | 3 years |
| Thapa et al. 1998 | Retrospective cohort | Tennessee, USA | 1993–1996 | 2428 | Amitriptyline; Imipramine; Nortriptyline; Paroxetine; Trazodone | Aged ≥65 years, no antidepressant use during the previous 90 days, restricted to new users of either tricyclic or other heterocyclic antidepressants, SSRI’s, or trazodone. (Users of multiple types of antidepressants and those for whom the primary reason for starting therapy was somatic e.g. migraine, peripheral neuropathy, or pain). | N/A |
| Trifiro et al. 2007 | Case–control | The Netherlands. Integrated Primary Care Information IPCI database. | 1996–2004 | 4430 | Clozapine; Olanzapine; Quetiapine; Risperidone | Aged ≥65 years, with dementia, at least 1 year recorded in IPIC database during study period | N/A |
| Uusvaara et al. 2011 | Prospective cohort | Helsinki, Finland. Drugs and Evidence-Based Medicine in the Elderly (DEBATE) study. | 1998–200 | 400 | AC drug class | Aged 75–90 years, non-institutionalised, diagnosis of CVD. | 3.3 years |
| Whalley et al. 2012 | Prospective cohort | NHS Grampian, Scotland. Scottish Mental Survey. | 1998–2000 | 281 | AC drug class | Aged between 78–83 years, living independently in the community. | 15 months to 5 years |
Abbreviations: ACB: Anticholinergic cognitive burden scale; AC: Anticholinergic; AC drug class: drugs classified as having anticholinergic effects by individual authors; ADS: Anticholinergic drug scale; CVD: Cardiovascular disease; DBI: Drug burden index; GI: gastrointestinal; MMSE: Mini Mental State Examination; NHS: National Health Service; N/A: not applicable; SSRIs: Selective serotonin reuptake inhibitors; SAA: Serum anticholinergic activity; UTIs: Urinary tract infections.