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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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