. 2020 Oct 23;40(1):28–37. doi: 10.1002/nau.24536

Table 1.

Qualitative summary of studies included in the meta‐analysis assessing the impact of anticholinergic agent use on incident dementia

Study	Design	Study setting/participants	Patient characteristics	Drug exposure assessment	Dementia assessment	Follow‐up/study duration	Risk of bias	Reported association
Ancelin 2006 ²⁶	Prospective cohort	General practitioner patients (France)	>60 years 77% women among users	Prevalent use at baseline and 1 year after	Neurologic examination based on DSM‐III‐R criteria^a	7 years	Moderate	No
Ancelin 2006 ²⁶	Prospective cohort	N = 327	>60 years 77% women among users	Prevalent use at baseline and 1 year after	Neurologic examination based on DSM‐III‐R criteria^a	7 years	Moderate	No
Coupland 2019 ⁸	Nested case‐control	QResearch database (UK)	≥55 years 63% women	10 years: 1–11 years before index date	Clinical code for dementia recorded in practice records or Office of National Statistics death records, or prescription for donepezil, galantamine, memantine, or rivastigmine	N/A	Moderate	Yes
Coupland 2019 ⁸	Nested case‐control	N = 284,343	≥55 years 63% women	10 years: 1–11 years before index date		N/A	Moderate	Yes
Gray 2015 ¹³	Prospective cohort	Sampled patients (GroupHEALTH, USA)	≥65 years 60% women	≥10 years of GroupHEALTH care plan enrollment	Cognitive Abilities Screening Instrument used. If score was ≤85, patient had a diagnostic evaluation for dementia^b	Mean (SD) follow‐up: 7.3 (4.8) years	Moderate	Yes/no depending on level of TSDD
Gray 2015 ¹³	Prospective cohort	N = 3434	≥65 years 60% women	≥10 years of GroupHEALTH care plan enrollment		Mean (SD) follow‐up: 7.3 (4.8) years	Moderate	Yes/no depending on level of TSDD
Hong 2019 ²⁷	Retrospective cohort	National Health Insurance Research Database (Taiwan)	≥45 years 52% women	1 year after index date	ICD‐9‐CM diagnosis code for dementia and record of mental function examination within the same visit^c	Mean (SD) follow‐up: 5.9 (3.4) years among unexposed, 5.7 (3.4) years among exposed	Moderate	Yes
Hong 2019 ²⁷	Retrospective cohort	N = 21,934	≥45 years 52% women	1 year after index date			Moderate	Yes
Park 2017 ²⁸	Nested case‐control	National Health Insurance Service (South Korea)	≥65 years 72% women	2 years before index date	ICD‐10‐CM diagnosis code for dementia	N/A	Moderate	Yes
Park 2017 ²⁸	Nested case‐control	N = 11,124	≥65 years 72% women	2 years before index date	ICD‐10‐CM diagnosis code for dementia	N/A	Moderate	Yes
Richardson 2018 ²⁹	Nested case‐control	Clinical Practice Research Datalink (UK)	65–99 years 63% women	Median (IQR, range) = 7.1 (4.0–11.3, 1–16) years before index date	Read code for dementia or prescription for memantine, donepezil, rivastigmine, galantamine, or tacrine if diagnosis of dementia was recorded within 12 months	N/A	Moderate	Yes
Richardson 2018 ²⁹	Nested case‐control	N = 324,703	65–99 years 63% women			N/A	Moderate	Yes

Abbreviations: CM, clinical modification; DSM, Diagnostic and Statistical Manual of Mental Disorders; ICD, International Classification of Diseases; IQR, interquartile range; NINCDS–ADRDA, National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association.

^{^a}

When examination was not possible, medical records were examined in collaboration with the patient's general practitioner to determine presence/absence of dementia.

^{^b}

A study neurologist, geriatrician, or internist performed a physical/neurologic examination, as well as neuropsychological testing. Results of the assessment, laboratory testing, and clinical data from medical records were reviewed for diagnosis using DSM‐IV and NINCDS–ADRDA criteria. Patients diagnosed with incident dementia had at least one follow‐up examination to confirm the dementia diagnosis.

^{^c}

Mental function examinations to confirm dementia diagnosis included the Clinical Dementia Rating, Cognitive Abilities Screening Instrument, or Mini‐Mental State Examination.