OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Dos autores de la revisión, de forma independiente, evaluaron los estudios para su inclusión y realizaron la extracción de los datos, la evaluación del riesgo de sesgo y la evaluación GRADE. CRITERIOS DE SELECCIÓN: Se incluyeron los estudios observacionales de cohortes y de casos y controles longitudinales prospectivos y retrospectivos con un seguimiento mínimo de un año, que examinaron la asociación entre una escala de medición de la carga anticolinérgica y el futuro deterioro cognitivo o demencia en adultos mayores sin deterioro cognitivo. MÉTODOS DE BÚSQUEDA: Se realizaron búsquedas en las siguientes bases de datos desde su creación hasta el 24 de marzo de 2021: MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCOhost) e ISI Web of Science Core Collection (ISI Web of Science). Existen varias escalas para medir la carga anticolinérgica, pero la concordancia entre ellas suele ser mala.Įvaluar si la carga anticolinérgica, definida a nivel de cada escala individual, es un factor pronóstico de un futuro deterioro cognitivo o demencia en adultos mayores sin deterioro cognitivo. Es posible que una alta carga anticolinérgica sea un factor de riesgo para la aparición de un deterioro cognitivo o la demencia. El efecto anticolinérgico acumulado de todos los fármacos que toma una persona se denomina "carga anticolinérgica" por su potencial para causar efectos adversos. There is low-certainty evidence that older adults without cognitive impairment who take medications with anticholinergic effects may be at increased risk of cognitive decline or dementia.Ī los adultos mayores se les prescriben con frecuencia fármacos con propiedades anticolinérgicas. Exploratory analysis combining adjusted ORs across available scales supported these results (OR 2.16, 95% CI 1.38 to 3.38), and there was evidence of variability in risk based on severity of anticholinergic burden (ACB scale 1: OR 2.18, 95% CI 1.11 to 4.29 ACB scale 2: OR 2.71, 95% CI 2.01 to 3.56 ACB scale 3: OR 3.27, 95% CI 1.41 to 7.61) however, overall GRADE evaluation of certainty of the evidence was low. Unadjusted ORs suggested an increased risk for cognitive decline or dementia in older adults with an anticholinergic burden (OR 1.47, 95% CI 1.09 to 1.96) and adjusted ORs similarly suggested an increased risk for anticholinergic burden, defined according to the ACB scale (OR 2.63, 95% CI 1.09 to 6.29). The Anticholinergic Cognitive Burden scale (ACB scale) was the only scale with sufficient data for 'scale-based' meta-analysis. Eight studies (320,906 participants) provided suitable data for meta-analysis. Twenty studies were conducted in the community care setting, two in primary care clinics, and three in secondary care settings. We identified 25 studies that met our inclusion criteria (968,428 older adults). We examined variability based on severity of anticholinergic burden. We initially established adjusted and unadjusted pooled rates for each available anticholinergic scale then, as an exploratory analysis, established pooled rates on the prespecified association across scales. We intended to pool each metric separately however, only OR-based data were suitable for pooling via a random-effects meta-analysis. We extracted odds ratios (OR) and hazard ratios, with 95% confidence intervals (CI), and linear data on the association between anticholinergic burden and cognitive decline or dementia. Two review authors independently assessed studies for inclusion, and undertook data extraction, assessment of risk of bias, and GRADE assessment. We included prospective and retrospective longitudinal cohort and case-control observational studies with a minimum of one year' follow-up that examined the association between an anticholinergic burden measurement scale and future cognitive decline or dementia in cognitively unimpaired older adults. We searched the following databases from inception to 24 March 2021: MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCOhost), and ISI Web of Science Core Collection (ISI Web of Science). To assess whether anticholinergic burden, as defined at the level of each individual scale, is a prognostic factor for future cognitive decline or dementia in cognitively unimpaired older adults. There are various scales available to measure anticholinergic burden but agreement between them is often poor. It is possible that high anticholinergic burden may be a risk factor for development of cognitive decline or dementia. The cumulative anticholinergic effect of all the medications a person takes is referred to as the 'anticholinergic burden' because of its potential to cause adverse effects. Medications with anticholinergic properties are commonly prescribed to older adults.
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