title: Differential effects of the antimuscarinic agents darifenacin and oxybutynin ER on memory in older subjects. Anti-cholinergic load, health care utilization, and survival in people with advanced cancer: a pilot study. Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: a randomized controlled trial. Assessment of cognitive function of the elderly population: effects of darifenacin. Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study Cumulative anticholinergic exposure is associated with poor memory and executive function in older men. Delirium in acute stroke: a preliminary study of the role of anticholinergic medications Anticholinergic medications in community-dwelling older veterans: prevalence of anticholinergic symptoms, symptom burden, and adverse drug events. Association of Anticholinergic Burden with Cognitive and Functional Status in a Cohort of Hospitalized Elderly: Comparison of the Anticholinergic Cognitive Burden Scale and Anticholinergic Risk Scale Association of Anticholinergic Drugs with Hospitalization and Mortality among Older Cardiovascular Patients Use of medications with anticholinergic properties and cognitive function in a young-old community sample. Exploratory pilot study assessing the risk of cognitive impairment or sedation in the elderly following single doses of solifenacin 10 mg Associations between drug burden index and falls in older people in residential aged care. Changes in cognitive functioning with risperidone and olanzapine treatment: a large-scale, double-blind, randomized study Association between prescribing of anticholinergic medications and incident delirium: a cohort study.
abstract: OBJECTIVES To investigate the effects of darifenacin controlled-release ( CR ) and oxybutynin extended-release ( ER ) on cognitive function ( particularly memory ) in older subjects . METHODS Healthy subjects ( n=150 ) > /=60 years were r and omised to darifenacin , oxybutynin ER or placebo in a multicentre , double-blind , double-dummy , parallel-group , 3-week study . Doses were administered according to US labels : oxybutynin ER 10 mg once daily ( od ) , increasing to 15 mg od then 20 mg od by week 3 ; darifenacin 7.5 mg od in weeks 1 and 2 , then 15 mg od in week 3 . The primary end point was accuracy on the Name-Face Association Test ( delayed recall ) at week 3 . RESULTS Results of the Name-Face Association Test at week 3 showed no significant difference between darifenacin and placebo on delayed recall ( mean difference , -0.06 , p=0.908 ) . In contrast , oxybutynin ER result ed in memory impairment , with significantly lower scores than placebo and darifenacin ( mean differences , -1.30 , p=0.011 and -1.24 , p=0.022 , respectively ) for delayed recall on the Name-Face Association Test at week 3 . Additional tests of delayed recall indicated significant memory impairment with oxybutynin ER versus placebo at certain time points , whereas darifenacin was similar to placebo . No between-treatment differences were detected in self-rated memory , demonstrating that subjects were unaware of memory deterioration . CONCLUSIONS While darifenacin had no significant effects on memory versus placebo , oxybutynin ER caused significant memory deterioration ( magnitude of effect comparable to brain aging of 10 years ) . The results also demonstrate that subjects may not recognise/report memory deterioration INTRODUCTION Anti-cholinergic medications have been associated with increased risks of cognitive impairment , premature mortality and increased risk of hospitalisation . Anti-cholinergic load associated with medication increases as death approaches in those with advanced cancer , yet little is known about associated adverse outcomes in this setting . METHODS A sub study of 112 participants in a r and omised control trial who had cancer and an Australia modified Karnofsky Performance Scale ( AKPS ) score ( AKPS ) of 60 or above , explored survival and health service utilisation ; with anti-cholinergic load calculated using the Clinician Rated Anti-cholinergic Scale ( modified version ) longitudinally to death . A st and ardised starting point for prospect ively calculating survival was an AKPS of 60 or above . RESULTS Baseline entry to the sub- study was a mean 62 + /- 81 days ( median 37 , range 1 - 588 ) days before death ( survival ) , with mean of 4.8 ( median 3 , SD 4.18 , range 1 - 24 ) study assessment s in this time period . Participants spent 22 % of time as an inpatient . There was no significant association between anti-cholinergic score and time spent as an inpatient ( adjusted for survival time ) ( p = 0.94 ) ; or survival time . DISCUSSION No association between anti-cholinergic load and survival or time spent as an inpatient was seen . Future studies need to include cognitively impaired population s where the risks of symptomatic deterioration may be more substantial BACKGROUND Observational studies report a relationship between anticholinergic drug scale ( ADS ) score and cognitive function . This study investigated whether a reduced ADS score improved cognitive function in a frail elderly population . METHODS This r and omized , controlled , single-blinded trial , recruited long-term residents with an ADS score of greater than or equal to 3 from 22 nursing homes in Norway . The participants were r and omly allocated ( 1:1 ) to intervention or control . The intervention was a pharmacist-initiated reduction of ADS score after multidisciplinary drug review s. Primary end point was Consortium to Establish a Registry for Alzheimer 's Disease 10-wordlist test for immediate recall . Secondary end points were Mini-Mental Sate Examination , delayed recall and recognition of words , saliva flow , and serum anticholinergic activity (SAA).The participants were retested after 4 and 8 weeks , and the study groups were compared after adjusting for baseline differences . RESULTS Eighty-seven patients were included . The median ADS score was reduced by 2 units ( p < .0001 ) in the intervention group and remained unchanged in the control group . After 8 weeks , the adjusted mean difference in immediate recall was 0.54 words between the intervention and control group ( 95 % confidence interval [ CI ] : -0.91 , 2.05 ; p = .48 ) . The study groups did not differ significantly in any of the other cognitive end points , salvia flow , or SAA at either follow-up ( p > .18 ) . CONCLUSION Pharmacist-initiated drug changes significantly reduced ADS score but did not improve cognitive function  in nursing home residents . Moreover , the drug changes did not reduce SAA or mouth dryness significantly , which might indicate limited applicability of the ADS score to prevent prescription risks in this population PURPOSE Overactive bladder is common in the elderly population , which is susceptible to cognitive disorders and drug induced cognitive impairment . Existing overactive bladder treatments may cause adverse events , such as cognitive impairment , due to antagonism of the M1 receptor in the central nervous system . In this study we evaluated the effect of darifenacin , an M3 selective antagonist , on cognitive function in elderly volunteers without clinical dementia . MATERIAL S AND METHODS This double-blind , 3-period crossover study r and omized 129 volunteers 65 years or older with no/mild cognitive impairment to receive 3 of 5 treatments , namely darifenacin controlled release ( 3.75 , 7.5 or 15 mg once daily ) , darifenacin immediate-release ( 5 mg 3 times daily ) or matching placebo for 14 days . Each treatment period was separated by 7 days of washout . Cognitive function tests were completed at baseline and at treatment end . RESULTS For the primary end points of memory scanning sensitivity , speed of choice reaction time and word recognition sensitivity , there were no statistically significant differences for darifenacin vs placebo . There were no statistically significant differences in secondary variables except memory scanning speed , which increased in all groups relative to baseline , but improvement was greater with placebo than with 3.75 mg darifenacin . Darifenacin treatment was not associated with changes in alertness , contentment or calmness , which are likely to be clinical ly relevant . Darifenacin was well tolerated . CONCLUSIONS : In elderly volunteers 2 weeks of treatment with darifenacin had no effect on cognitive function compared with baseline and it was not significantly different from placebo . This may be related to its M3 receptor selectivity with negligible M1 receptor antagonism Abstract Objective To assess the potential of anticholinergic drugs as a cause of  non-degenerative mild cognitive impairment in elderly people . Design Longitudinal cohort study . Setting 63 r and omly selected general practice s in the Montpellier region of southern France . Participants 372 people aged > 60 years without dementia at recruitment . Main outcome measures Anticholinergic burden from drug use , cognitive examination , and neurological assessment . Results 9.2 % of subjects continuously used anticholinergic drugs during the year before cognitive assessment . Compared with non-users , they had poorer performance on reaction time , attention , delayed non-verbal memory , narrative recall , visuospatial construction , and language tasks but not on tasks of reasoning , immediate and delayed recall of wordlists , and implicit memory . Eighty per cent of the continuous users were classified as having mild cognitive impairment compared with 35 % of non-users , and anticholinergic drug use was a strong predictor of mild cognitive impairment ( odds ratio 5.12 , P = 0.001 ) . No difference was found between users and non-users in risk of developing dementia at follow-up after eight years . Conclusions Elderly people taking anticholinergic drugs  had significant deficits in cognitive functioning and were highly likely to be classified as mildly cognitively impaired , although not at increased risk for dementia . Doctors should assess current use of anticholinergic drugs in elderly people with mild cognitive impairment before considering administration of acetylcholinesterase inhibitors OBJECTIVES To examine the longitudinal relationship between cumulative exposure to anticholinergic medications and memory and executive function in older men . DESIGN Prospect i ve cohort study . SETTING A Department of Veterans Affairs primary care clinic . PARTICIPANTS Five hundred forty-four community-dwelling men aged 65 and older with diagnosed hypertension . MEASUREMENTS The outcomes were measured using the Hopkins Verbal Recall Test ( HVRT ) for short-term memory and the instrumental activity of daily living ( IADL ) scale for executive function at baseline and during follow-up . Anticholinergic medication use was ascertained using participants ' primary care visit records and quantified as total anticholinergic burden using a clinician-rated anticholinergic score . RESULTS Cumulative exposure to anticholinergic medications over the preceding 12 months was associated with poorer performance on the HVRT and IADLs . On average , a 1-unit increase in the total anticholinergic burden per 3 months was associated with a 0.32-point ( 95 % confidence interval (CI)= 0.05 - 0.58 ) and 0.10-point ( 95 % CI=0.04 - 0.17 ) decrease in the HVRT and IADLs , respectively , independent of other potential risk factors for cognitive impairment , including age , education , cognitive and physical function , comorbidities , and severity of hypertension . The association was attenuated but remained statistically significant with memory ( 0.29 , 95 % CI=0.01 - 0.56 ) and executive function ( 0.08 , 95 % CI=0.02 - 0.15 ) after further adjustment for concomitant non-anticholinergic medications . CONCLUSION Cumulative anticholinergic exposure across multiple medications over 1 year may negatively affect verbal memory and executive function in older men . Prescription of drugs with anticholinergic effects in older persons deserves continued attention to avoid deleterious adverse effects The pathogenesis of delirium in acute stroke is incompletely understood . The use of medications with anticholinergic ( ACH ) activity is associated with an increased frequency of delirium . We hypothesized that the intake of medications with ACH activity is associated with delirium in acute stroke patients . Delirium was assessed using the DSM‐IV‐TR criteria and the Delirium Rating Scale , in a sample of consecutive patients with an acute ( ≤4 days ) cerebral infa rct or intracerebral haemorrhage ( ICH ) . We performed a gender and age matched case – control study . Twenty‐two delirious stroke patients ( cases ) and 52 non‐delirious patients ( controls ) were compared concerning the intake of  ACH medications ( i ) before stroke , ( ii ) during hospitalization but before the assessment . The variables associated with delirium on bivariate analysis were entered in a stepwise logistic regression analysis . The final regression model ( Nagelkerke R2 = 0.65 ) retained  non‐neuroleptics ACH medication during hospitalization ( OR = 24.4 ; 95 % CI = 2.18–250 ) , medical complications ( OR = 20.8 ; 95 % CI = 3.46–125 ) , ACH medication taken before stroke ( OR = 17.5 ; 95 % CI = 1.00–333.3 ) and ICH ( OR = 16.9 ; 95 % CI = 2.73–100 ) as independent predictors of delirium . This preliminary result indicates that drugs with subtle ACH activity play a role in the pathogeneses of delirium in acute stroke . Medication with ACH activity should be avoided in acute stroke patients BACKGROUND The use of drugs with anticholinergic adverse effects is often deemed inappropriate in elderly ( aged > or = 65 years ) patients , yet studies continue to show extensive use in this population at high risk for adverse drug events ( ADEs ) . The burden of drug-related anticholinergic symptoms in community-dwelling elderly patients has not been well described . OBJECTIVE The aim of this study was to assess the prevalence of anticholinergic symptoms , corresponding symptom burden , and anticholinergic-related ADEs in a sample of community-dwelling elderly veterans . METHODS This prospect i ve cohort study was conducted at the primary care clinics at the Veterans Affairs Medical Center ( VAMC ) , Iowa City , Iowa . The study sample included r and omly selected patients with intact cognitive function attending the VAMC and prescribed > or = 5 scheduled medications . Data on current prescription and nonprescription drug use were elicited by a trained research assistant and a clinical pharmacist from patient interviews and electronic medical records . The prevalence and severity of 7 anticholinergic symptoms ( dry mouth , constipation , blurred vision , confusion , urinary hesitation , dry eyes , and drowsiness ) were assessed at baseline . The occurrence of ADEs at 12 weeks was compared between patients using anticholinergic drugs and those not using them . RESULTS A total of 532 patients were included ( 97.9 % men ; mean age , 74.3 years ; 27.1 % used at least 1 anticholinergic drug )  . Twenty-two anticholinergic drugs ( 16 prescription medications , 6 over-the-counter medications ) were identified . The mean number of anticholinergic symptoms was significantly higher in the group using anticholinergic drugs ( 3.1 vs 2.5 ; P < 0.01 ) . However , only 2 symptoms were statistically more prevalent in the group using anticholinergic drugs : dry mouth ( 57.6 % vs 45.6 % ) and constipation ( 42.4 % vs 29.4 % ) ( both , P < 0.01 ) . At 12 weeks , only 1 ( 0.8 % ) patient in the group using anticholinergic drugs reported an ADE considered related to an anticholinergic drug . CONCLUSIONS Anticholinergic drug use was common ( 27.1 % ) in these elderly veterans with intact cognitive function . The mean number of anticholinergic symptoms was significantly greater in this group , and the prevalences of dry mouth and constipation were significantly higher in the group using anticholinergic drugs ( all , P < 0.01 ) . Anticholinergic-related ADEs were rare ( 0.8 % ) . Although anticholinergic drugs should generally be avoided in the elderly , individual risks and benefits for a patient should be considered Background Drugs with anticholinergic effects are associated with adverse events such as delirium and falls as well as cognitive decline and loss of independence . Objective The aim of the study was to evaluate the association between anticholinergic burden and both cognitive and functional status , according to the hypothesis that the cumulative anticholinergic burden , as measured by the Anticholinergic Cognitive Burden ( ACB ) Scale and Anticholinergic Risk Scale ( ARS ) , increases the risk of cognitive decline and impairs activities of daily living . Methods This cross-sectional , prospect i ve study ( 3-month telephone follow-up ) was conducted in 66 Italian internal medicine and geriatric wards participating in the Registry of Polytherapies SIMI ( Società Italiana di Medicina Interna ) ( REPOSI ) study during 2010 . The sample included 1,380 in patients aged 65 years or older . Cognitive status was rated with the Short Blessed Test ( SBT ) and physical function with the Barthel Index . Each patient ’s anticholinergic burden was evaluated using the ACB and ARS scores . Results The mean SBT score for patients treated with anticholinergic drugs was higher than that for patients receiving no anticholinergic medications as also indicated by the ACB scale , even after adjustment for age , sex , education , stroke and transient ischaemic attack [ 9.2 ( 95 % CI 8.6–9.9 ) vs. 8.5 ( 95 % CI 7.8–9.2 ) ; p = 0.05 ] . There was a dose – response relationship between total ACB score and cognitive impairment . Patients identified by the ARS had more severe cognitive and physical impairment than patients identified by the ACB scale , and the dose – response relationship between this score and ability to perform activities of daily living was clear . No correlation was found with length of hospital stay . Conclusions Drugs with anticholinergic properties identified by the ACB scale and ARS are associated with worse cognitive and functional performance in elderly patients . The ACB scale might permit a rapid identification of drugs potentially associated with cognitive impairment in a dose – response pattern , but the ARS is better at rating activities of daily living Abstract Background : Many potentially inappropriate drugs prescribed to older people have anticholinergic properties as adverse effects and are therefore potentially harmful . These effects typically include constipation , dry mouth , blurred vision , dizziness and slowing of urination . It has been shown that drugs with anticholinergic properties ( DAPs ) are associated with cognitive decline and dementia , may contribute to events such as falls , delirium and impulsive behaviour , are associated with self-reported adverse effects and physical impairment , and may even be associated with mortality . However , studies of the prognostic implication s of DAPs remain scarce . Objective : To evaluate the impact of DAPs on hospitalization and mortality in older patients with stable cardiovascular disease ( CVD ) . Methods : This was a prospect i ve study with a mean follow-up of 3.3 years involving two study groups : users ( n = 295 ) and non-users ( n = 105 ) of DAPs . The participants were 400 community-dwelling older people ( aged 75–90 years ) with stable CVD participating in a secondary prevention study of CVD ( DEBATE ) in Helsinki , Finl and . The use of DAPs was estimated using definitions from the previous scientific literature . The Charlson Comorbidity Index ( CCI ) was used to estimate the burden of co-morbidity and the Mini-Mental State Examination test was used to assess cognitive function . The risks in the two study groups for hospital visits , number of days spent in hospital care and mortality were measured from 2000 to the end of 2003 . Results : The unadjusted follow-up mortality was 20.7 % and 9.5 % among the users and non-users of DAPs , respectively ( p = 0.010 ) . However , the use of DAPs was not a significant predictor of mortality in multivariate analysis after adjustment for age , sex and CCI score ( hazard ratio 1.57 ; 95 % CI 0.78 , 3.15 ) . The mean ± SD number of hospital days per person-year was higher in the DAP user group ( 14.9± 32.5 ) than in the non-user group ( 5.2± 12.3 ) [ p < 0.001 ] . In a bootstrap-type analysis of covariance adjusted for age , sex and CCI score , the use of DAPs predicted the number of days spent in hospital ( p = 0.011 ) . Conclusions : The use of DAPs in older patients with stable CVD was associated with an increased number of hospital days but not with mortality OBJECTIVES To examine whether anticholinergic medications have effects on the level of cognitive function or cognitive decline  in persons in their early to mid 60s . METHODS A r and omly selected community-based sample of 2058 persons aged 60 - 64 at baseline was interviewed twice over four years . Anticholinergic medication use was determined from self-report medication data using the Anticholinergic Drug Scale . Cognition was assessed with the California Verbal Learning Test I ( one trial ) , Digits Backwards , the Symbol Digit Modalities Test , the Mini-Mental State Exam and simple and choice reaction time .  Persons meeting criteria for Mild Cognitive Impairment were identified in a clinical sub study . Mixed models adjusting for age , sex , self-rated depression and physical health , and total number of medications were used to analyse the data . RESULTS There was a significant main effect of anticholinergic group averaged across time for the Symbol Digits Modalities Test with poorer performance among anticholinergic medication users . Main effects for the other cognitive tests and mild cognitive impairment were non-significant . No time by anticholinergic group interactions were significant . CONCLUSIONS This study suggests that exposure to anticholinergic medication is associated with lower level of complex attention in the young-old , but not with greater cognitive decline over time . Although the clinical significance of this is not clear , caution should be taken when prescribing medications with anticholinergic effects to older persons Objectives : To assess the cognitive effects of single doses of solifenacin 10 mg compared with placebo ( primary objective ) and oxybutynin immediate release ( IR ) 10 mg ( secondary objective ) in elderly subjects . Methods : Single-centre , r and omised , double-blind , placebo-controlled study in 12 healthy elderly volunteers , with three crossover periods separated by two 14-day washout periods . Each sequence consisted of a single dose of solifenacin 10 mg in one period , oxybutynin IR 10 mg in another and placebo in another . Aspects of attention , information processing , working memory , episodic memory and self-rated mood and alertness were tested using the vali date d Cognitive Drug Research computerised assessment system . Results : There was no evidence from absolute mean values or changes from baseline to suggest that solifenacin 10 mg impaired cognition or self-ratings of mood and alertness versus placebo . Post-hoc ANCOVA showed no statistically significant cognitive deterioration with solifenacin versus placebo , when measured at a time point closest to the probable Cmax of solifenacin . Oxybutynin was associated with statistically significant impairments in several measures of cognitive function at a time point corresponding with its probable Cmax . Conclusion : In this pilot study , single 10 mg doses of solifenacin did not show any clear propensity to impair cognitive function in a healthy elderly population OBJECTIVES To evaluate the association between the Drug Burden Index ( DBI ) , a measure of a person 's total exposure to anticholinergic and sedative medications that includes principles of dose-response and maximal effect and is associated with impaired physical function in community-dwelling older people , and falls in residents of residential aged care facilities ( RACFs ) . DESIGN Data were drawn from participants in a r and omized controlled trial that investigated falls and fractures . SETTING RACFs in Sydney , Australia . PARTICIPANTS Study participants ( N=602 ; 70.9 % female ) were recruited from 51 RACFs . Mean age was 85.7 ± 6.4 , and mean DBI was 0.60 ± 0.66 . MEASUREMENTS Medication history was obtained on each participant . Drugs were classified as anticholinergic or sedative and a DBI was calculated . Falls were measured over a 12-month period . Comorbidity , cognitive impairment ( Mini-Mental State Examination ) and depression ( Geriatric Depression Scale ) were determined . RESULTS There were 998 falls in 330 individuals during a follow-up period of 574.2 person-years , equating to an average rate of 1.74 falls per person-year . The univariate negative binomial regression model for falls showed incidence rate ratios of 1.69 ( 95 % confidence interval (CI)=1.22 - 2.34 ) for low DBI ( < 1 ) and 2.11 ( 95 % CI=1.47 - 3.04 ) for high DBI ( ≥1 ) when compared with those who had a DBI of 0 . After adjusting for age , sex , history of falling , cognitive impairment , depression , use of a walking aid , comorbidities , polypharmacy , and incontinence , incident rate ratios of 1.61 ( 95 % CI=1.17 - 2.23 ) for low DBI and 1.90 ( 95 % CI=1.30 - 2.78 ) for high DBI were obtained . CONCLUSION DBI is significantly and independently associated with falls in older people living in RACFs . Interventional studies design ed for this population are needed to determine whether reducing DBI , through dose reduction or cessation of anticholinergic and sedative drugs , can prevent falls Objective The effects of risperidone and olanzapine on cognitive functioning in patients with schizophrenia were compared in a r and omized , double-blind trial . Method Three hundred and seventy-seven patients were r and omly assigned to receive 2–6 mg/day of risperidone or 5–20 mg/day of olanzapine for 8 weeks . Cognitive function was assessed with a focused cognitive assessment battery ; in addition , extrapyramidal symptoms were assessed using the extrapyramidal symptom rating scale ( ESRS ) , and the positive and negative syndrome scale ( PANSS ) was rated for all patients . Results Treatment with these two atypical antipsychotic medications was associated with improved performance on the Wisconsin card sorting test , the trail-making test , the California verbal learning test , the continuous performance test , and some aspects of verbal fluency and spatial working memory . No differences in the effects of the drugs on any of the cognitive tests were noted . Correcting for the effects of anticholinergic treatment did not alter the magnitude of cognitive effects . Conclusions Atypical antipsychotic treatment is associated with wide-ranging benefits on cognitive functioning . Previous reports of greater benefits of olanzapine over risperidone in a small- sample pilot study were not substantiated . These results are not due in general to changes in clinical symptoms or movement disorders , suggesting a direct effect of atypical antipsychotic medications on cognitive deficits in schizophrenia OBJECTIVES To describe the association between anticholinergic medications and incident delirium in hospitalized older adults with cognitive impairment and to test the hypothesis that anticholinergic medications would increase the risk of incident delirium . DESIGN Observational cohort study . SETTING Urban public hospital in Indianapolis , Indiana . PARTICIPANTS One hundred forty-seven participants aged 65 and older with cognitive impairment who screened negative for delirium at the time of admission to a general medical ward . MEASUREMENTS Cognitive function at the time of admission was assessed using the Short Portable Mental Status Question naire ( SPMSQ ) .  Anticholinergic medication orders between the time of admission and the final delirium assessment were evaluated . Anticholinergic medication orders were identified using the Anticholinergic  Cognitive Burden Scale . Delirium was assessed using the Confusion Assessment Method . RESULTS Fifty-seven percent of the cohort received at least one order for possible anticholinergic medications , and 28 % received at least one order for definite anticholinergic medications . The incident rate for delirium was 22 % of the entire cohort . After adjusting for age , sex , race , baseline SPMSQ score , and Charlson Comorbidity Index , the odds ratio ( OR ) for developing delirium in those with orders for possible anticholinergic medications was 0.33 ( 95 % confidence interval ( CI ) = 0.10 - 1.03 ) . The OR for developing delirium among those with orders for definite anticholinergic medications was 0.43 ( 95 % CI = 0.11 - 1.63 ) . CONCLUSION The results did not support the hypothesis that prescription of anticholinergic medications increases the risk of incident delirium in hospitalized older adults with cognitive impairment . This relationship needs to be established using prospect i ve study design s with medication dispensing data to improve the performance of predictive models of delirium
target: medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes
background: OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .