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Use of Medications With Anticholinergic Effect Predicts Clinical Severity of Delirium Symptoms in Older Medical Inpatients
Ling Han, MD, MSc;
Jane McCusker, MD, DrPH;
Martin Cole, MD, FRCPC;
Michal Abrahamowicz, PhD;
François Primeau, MD, FRCPC;
Michel Élie, MD, FRCPC
Arch Intern Med. 2001;161:1099-1105.
Background Use of anticholinergic (ACH) medications is a biologically plausible
and potentially modifiable risk factor of delirium, but research findings
are conflicting regarding its association with delirium.
Objectives To evaluate the longitudinal association between use of ACH medications
and severity of delirium symptoms and to determine whether this association
is modified by the presence of dementia.
Patients and Methods A total of 278 medical inpatients 65 years and older with diagnosed
incident or prevalent delirium were followed up with repeated assessments
using the Delirium Index for up to 3 weeks. Exposure to ACH and other medications
was measured daily. The association between change in medication exposure
in the 24 hours preceding a Delirium Index assessment was assessed using a
mixed linear regression model.
Results During follow-up (mean ± SD, 12.3 ± 7.0 days), 47 medications
with potential ACH effect were used in the population (mean, 1.4 medications
per patient per day). Increase in delirium severity was significantly associated
with several measures of ACH medication exposure on the previous day, adjusting
for dementia, baseline delirium severity, length of follow-up, and number
of non-ACH medications taken. Dementia did not modify the association between
ACH medication use and delirium severity.
Conclusion Exposure to ACH medications is independently and specifically associated
with a subsequent increase in delirium symptom severity in elderly medical
inpatients with diagnosed delirium.
From the Departments of Psychiatry (Drs Han, Cole, Primeau, and Élie)
and Clinical Epidemiology and Community Studies (Drs Han, McCusker, and Abrahamowicz),
St Mary's Hospital Center, and the Department of Clinical Epidemiology, Montreal
General Hospital, McGill University (Dr Abrahamowicz), Montreal, Quebec.
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