| Hospital non-surgical |
| Ceppi, 2023 |
ACB |
Anticholinergics taken by patient at hospital admission, single time point |
Age, sex, rehabilitation discipline, index date and time span between admission and index date |
Incident delirium |
ACB ≥3 vs <3: OR 2.59 (1.41-4.73)* |
| Lee, 2021 |
ACB |
Anticholinergics being taken by patients at hospital admission, single time point |
Age, Sex, CCI, number of medications, length of stay, types of cancer, admission through emergency department, vital signs, laboratory results |
Incident delirium |
Patients with an increase in ACB score vs those with no increase: OR 13.45 (2.78-64.96)* |
| Rigor, 2020 |
ACB |
Anticholinergics being taken by patients at hospital admission – single time point |
Age, sex, CCI, dementia, number of comorbidities, number of outpatient drugs, number of inpatient drugs, number of outpatient ACB drugs, number of inpatient ACB drugs |
Incident Delirium |
ACB:
Number of medications: OR 0.55 (0.27 – 1.13)
Sum of points: OR 1.65 (1.09 – 2.51)* |
| Vondeling, 2020 |
ADS |
Anticholinergics being taken by patients at hospital admission – single time point |
Age, sex, drinking status, SOFA, APACHE IV, depression, diabetes, hypertension, sepsis or septic shock, cerebrovascular disease, cardiac failure, elective ICU admission (vs emergency), surgery before ICU admission |
Incident delirium |
ADS Sum of points:
All patients:
1 vs 0: sHR 1.13 (0.91 - 1.40)
≥2 vs 0: sHR 1.32 (1.06 - 1.64)*
Age ≥ 65 years, no severe sepsis and/or septic shock:
1 vs 0: sHR 1.52 (0.99 - 2.33)*
≥2 vs 0: sHR 2.15 (1.43 - 3.25)*
Age ≥ 65 years, severe sepsis and/or septic shock:
1 vs 0: sHR 0.75 (0.47 - 1.20)
≥2 vs 0: sHR 0.84 (0.51 - 1.39) |
| Caeiro, 2004 |
None |
ACH use vs non-use prior to admission - single time point |
Non-neuroleptics ACH during hospitalization, medical complications, ACH taken before stroke and ICH |
Prevalent delirium |
ACH use vs non-use before stroke: OR 11.3 (1.19-108.2)* |
| Egberts, 2017 |
ARS, ACB, List of Chew |
Anticholinergics taken by patient at hospital admission, single time point |
Age, sex, number of medications |
Prevalent delirium |
ARS:
Use vs non-use: OR 1.73 (1.23 - 2.45)*
Number of medications OR 1.38 (1.10 - 1.73)*
Sum of points:
1-2 vs 0 OR 1.7 (1.16 - 2.49)*
≥ 3 vs 0 OR 1.83 (1.06 - 3.15)*
ACB:
Use vs non-use: OR 1.1 (0.77 - 1.59)
Number of medications: OR 1.07 (0.94 - 1.23)
Sum of points:
1-2 vs 0: OR 0.99 (0.67 - 1.46)
≥3 vs 0: OR 1.39 (0.89 - 2.18)
List of Chew:
Use vs non-use: OR 1.09 (0.78 - 1.51)
number of medications: OR 1.11 (0.94 - 1.31)
Sum of points:
0.5-1 vs 0: OR 1 (0.71 - 1.43)
≥1.5 vs 0: OR 1.34 (0.85 - 2.11) |
| Moorey, 2016 |
ACB, ADS |
Anticholinergics being taken by patients at hospital admission, single time point |
Age, number of anticholinergics, polypharmacy, anticholinesterase use |
Prevalent delirium |
Non-significant, Not reported |
| Naja, 2015 |
Combined ACB - ADS |
Anticholinergics being taken by patients before hospital admission, single time point |
Age, sex, education, CCI, cognitive level (MMSE), sensorial disturbances, marital status, place of residence (with spouse or other family member, alone or in an institution), socioeconomic level before retirement, perceived health status on a numeric scale (0-10), number of previous hospitalizations, creatinine clearance, serum albumin |
Prevalent delirium |
Anticholinergic burden at home with delirium at day 1, day 3, day 5, day 8, day 15 Not significant |
| Pasina, 2019 |
ACB |
Anticholinergics being taken by patients at hospital admission, single time point |
Age, sex, dementia, cancer, mini nutritional assessment |
Prevalent delirium |
ACB sum of points:
1 vs 0: OR 0.93 (0.49-1.79)
2 vs 0: OR 1.01 (0.47-2.16)
3 vs 0: OR 1.81 (0.74-4.47)
4 vs 0: OR 2.19 (0.87-5.53)
≥5 vs 0: OR 2.73 (0.85-8.77) |
| Wahab, 2019 |
ADS |
Anticholinergics being taken by patients at hospital admission, single time point |
Age, sex, drinking status, smoking status, number of medications, comorbidities |
Prevalent delirium |
ADS use vs non-use: OR 3.6 (1.55-8.37)* |
| Rawle, 2021 |
ACB |
Anticholinergics being taken by patients at hospital admission, single time point |
Univariate |
Subsyndromal Delirium prevalence,
Full syndromal delirium prevalence |
ACB sum of points:
Subsyndromal Delirium
1 vs 0: OR 0.86 (0.49 - 1.51)
2 vs 0: OR 0.88 (0.42 - 1.82)
≥3 vs 0: OR 1.61 (0.89 - 2.94)
Full Syndromal Delirium
1 vs 0: OR 1.06 (0.59 - 1.93)
2 vs 0: OR 0.72 (0.30 - 1.72)
≥3 vs 0: OR 1.49 (0.76 - 2.94) |
| Surgical |
| Duprey, 2022 |
ACB, ADS |
Anticholinergics taken by patients 2 weeks before surgery, single time point |
Age, Sex, CCI, Surgery type, Baseline GCP, APACHE-II, The number of medications with anticholinergic activity |
Incident delirium |
ACB number of medications: RR: 1.03 (0.88-1.20)
ADS number of medications: RR: 1.03 (0.87-1.22) |
| Ferre, 2022 |
Duran et al.114 and Laroche et al115 |
Anticholinergics being taken by patients at hospital admission, single time point |
CIRS-G frailty score, prehospital AB, In-hospital AB |
Incident delirium |
Non-significant, not reported |
| Heinrich, 2021 |
ARS, ACB, ADS |
Long term medications taken regularly at time of study enrollment, single time point |
Age, CCI, duration of anesthesia, number of long-term medications |
Incident delirium |
ADS:
Number of medications: OR 0.955 (0.62-1.46)
Sum of points: OR 0.928 (0.74 -1.15)
ARS:
Number of medications: OR 0.784 (0.37-1.63)
Sum of points: OR 0.832 (0.56-1.22)
ACB:
Number of medications: OR 1.13 (0.762-1.68)
Sum of points: OR 1.045 (0.84-1.29) |
| Herrmann, 2022 |
ARS, ABS67 |
Long term medications taken for more than 3 days a week at hospital admission, single time point |
Age, sex, CCI, number of medications, Surgery type, ICU stay, preoperative serum creatinine, type of anesthesia, usage of heart-lung-machine |
Incident delirium |
ARS Sum of points: OR 1.54 (1.15-2.02)*
ABS Number of medications: OR 2.74 (1.55-4.49)* |
| Mueller, 2020 |
ADS |
Long term anticholinergics taken every day before hospital admission, single time point |
Age, Sex, CCI, duration of anesthesia, ASA, severity of surgery, Number of prescribed long-term drugs |
Incident delirium |
ADS:
sum of points: OR 1.50 (1.09-2.05)*
use vs non-use: OR 2.21 (1.21-4.04)* |
| Tillemans, 2021 |
ADS, Dutch expert panel scale (0-2) |
Anticholinergics being taken by patients at hospital admission, single time point |
Univariate |
Delirium duration and severity |
Non-significant, Not reported |
| Nursing home or long term care |
| Landi, 2014 |
ARS |
Anticholinergics received by patients during 7 days preceding baseline assessment, single time point |
Age, Sex, cognitive level (CPS), depression, schizophrenia, comorbidities, CIRS |
Incident delirium during 1-year follow up |
ARS sum of points: OR 1.16 (1.02-1.32)* |
| Oudewortel, 2021 |
ARS, ACB |
Anticholinergics received by patients for 3 days preceding baseline assessment – single time point |
Age, CCI, cognitive level (CPS) |
Prevalent delirium |
Patients with dementia:
ARS sum of points 1.17 (1.04 - 1.31)*
ARS none, moderate, strong 1.26 (0.99 - 1.49)
ACB sum of points 1.14 (1.06 - 1.23)*
ACB none, moderate, strong 1.26 (1.11 - 1.44)*
Patients without dementia:
ARS sum of points 1.07 (0.94 - 1.21)
ARS none, moderate, strong 1.1 (0.86 - 1.43)
ACB sum of points 1.07 (0.97 - 1.18)
ACB none, moderate, strong 1.14 (0.94 - 1.38) |
| Pasina, 2021 |
ACB |
Anticholinergics being taken by patients at hospital admission – single time point |
Age, sex, dementia, cancer, karnofsky performance score, days of palliative assistance, care setting (hospice or home). |
Prevalent delirium |
ACB sum of points:
1 vs 0: OR 0.62 (0.16-2.43)
2 vs 0: OR 0.44 (0.11-1.72)
3 vs 0: OR 1.85 (0.52-6.61)
4 vs 0: OR 1.53 (0.39-6.00)
≥5 vs 0: OR 2.25 (0.69-7.28) |
| Population based |
| Huang, 2012 |
ARS |
Patients taking at least 1 anticholinergic during a 1-year observation period |
Age, sex, CCI, number of medications, presence of chronic disease |
Incident delirium during 6 month follow up |
ARS use vs non-use: OR 1.51 (1.18-1.93)* |
| Ah, 2019 |
Modified ACB |
Average daily ACB, 3 months |
Age, sex, depression, diabetes, hyperlipidemia, stroke, hypertension, sedative drugs, parkinson's disease, use of prescription drugs with gingko extract during the first 90 days |
Incident delirium during 1 year follow up |
Average daily ACB score >3: HR 1.52 (1.17-1.96)* |
| Hwang, 2019 |
Modified ARS |
Average daily ARS, 3 months |
Age, sex, insurance type, comorbid conditions, sedative drugs, polypharmacy, excessive polypharmacy, exposure to sedative drugs, warfarin, insulin, digoxin |
Incident delirium during 3 month follow up |
Average daily ARS ≥2 vs ≤2: HR 2.05 (1.13 - 3.73)* |
| Hwang, 2021 |
ARS, ACB, ADS, KABS |
Average daily anticholinergic burden, 30 days |
Age, Sex, CCI, insurance type, comorbid conditions, sedative drugs, concomitant chronic medications prescribed for more than 18 days during a month, use of digoxin, use of Insulin, use of Warfarin |
Incident delirium during 6 month follow up |
Average daily KABS
1 vs 0: 1.36 (1.12-1.66)*
2 vs 0: 1.91 (1.46-2.50)*
≥3 vs 0: 2.96 (2.28-3.83)*
Average daily ARS
1 vs 0: 1.14 (0.92-1.41)
2 vs 0: 1.92 (1.32-2.77)*
≥3 vs 0: 2.32 (1.33-4.03)*
Average Daily ACB
1 vs 0: 1.05 (0.86-1.26)
2 vs 0: 1.57 (1.21-2.04) *
≥3 vs 0: 2.22 (1.69-2.90)*
Average daily ADS
1 vs 0 1.39 (1.15-1.68)*
2 vs 0:1.56 (1.19-2.05)*
≥3 vs 0: 2.55 (1.91-3.40)* |