The Effect of Anticholinergic Medications on People living with Dementia: A Systematic Literature Review.

Abstract: Abstract: Background: Dementia is a global public health concern as it causes high dependency of the patients with Dementia (PwD) on their families and the community. Dementia is an irreversible neurodegenerative disorder for the elderly often associated with many comorbidities such as hypertension, diabetes, kidney diseases, etc. which require different medications for treatment. The use of Anticholinergic (AC) medication is common among People living with Dementia (PwD). The current Systematic Literature review aims to compile the evidence on the worst outcome of AC medication’s adverse effects on PwD. Method: A systematic literature search was performed in PubMed, Web of Science, and Google scholar from January 1, 2000, to January 31, 2022. "The Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guideline and population, exposure, control, outcomes, and setting (PECOS) inclusion and exclusion criteria have been followed to include studies for full-text review. EndNote and Covidence software was used for the selection of studies and the extraction of data from the selected studies. The Newcastle-Ottawa Scale (NOS) was followed to judge the quality of the included studies. Result: The primary database search identified 532 articles, and after removing duplicates, 377 articles have been included for screening. After screening and full-text review, 15 articles have been included for data extraction. The mortality rate due to adverse effects of AC medication was found to be higher; the adjusted Hazard Ratio (aHR) ranges from 1.09 to 1.23. Additionally, the outcome of hospitalization was increased with simultaneous use of more than one AC medication. Other outcomes such as Mortality, Hospitalization, and Cognitive impairments showed the negative contribution of the AC. However, eleven out of fifteen studies meet the high-quality study criteria of The Newcastle Ottawa Scale (NOS). Conclusion: AC medication is associated with an increased rate of mortality, cognitive impairment, and hospitalization among PwD. Therefore, health care professionals need to be cautious while prescribing AC for PWD.