Skip to main content

Advertisement

SpringerLink
Log in

Anticholinergic Drug Burden Tools/Scales and Adverse Outcomes in Different Clinical Settings: A Systematic Review of Reviews

  • Systematic Review
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Background

Cumulative anticholinergic exposure (anticholinergic burden) has been linked to a number of adverse outcomes. To conduct research in this area, an agreed approach to describing anticholinergic burden is needed.

Objective

This review set out to identify anticholinergic burden scales, to describe their rationale, the settings in which they have been used and the outcomes associated with them.

Methods

A search was performed using the Healthcare Databases Advanced Search of MEDLINE, EMBASE, Cochrane, CINAHL and PsycINFO from inception to October 2016 to identify systematic reviews describing anticholinergic burden scales or tools. Abstracts and titles were reviewed to determine eligibility for review with eligible articles read in full. The final selection of reviews was critically appraised using the ROBIS tool and pre-defined data were extracted; the primary data of interest were the anticholinergic burden scales or tools used.

Results

Five reviews were identified for analysis containing a total of 62 original articles. Eighteen anticholinergic burden scales or tools were identified with variation in their derivation, content and how they quantified the anticholinergic activity of medications. The Drug Burden Index was the most commonly used scale or tool in community and database studies, while the Anticholinergic Risk Scale was used more frequently in care homes and hospital settings. The association between anticholinergic burden and clinical outcomes varied by index and study. Falls and hospitalisation were consistently found to be associated with anticholinergic burden. Mortality, delirium, physical function and cognition were not consistently associated.

Conclusions

Anticholinergic burden scales vary in their rationale, use and association with outcomes. This review showed that the concept of anticholinergic burden has been variably defined and inconsistently described using a number of indices with different content and scoring. The association between adverse outcomes and anticholinergic burden varies between scores and has not been conclusively established.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Salahudeen MS, Duffull SB, Nishtala PS. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr. 2015;15:31.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Cardwell K, Hughes CM, Ryan C. The association between anticholinergic medication burden and health related outcomes in the ‘oldest old’: a systematic review of the literature. Drugs Aging. 2015;32(10):835–48.

    Article  PubMed  CAS  Google Scholar 

  3. Durán CE, Azermai M, Vander Stichele RH. Systematic review of anticholinergic risk scales in older adults. Eur J Clin Pharmacol. 2013;69(7):1485–96.

    Article  PubMed  CAS  Google Scholar 

  4. Zimmerman KM, Salow M, Skarf LM, et al. Increasing anticholinergic burden and delirium in palliative care inpatients. Palliat Med. 2014;28(4):335–41.

    Article  PubMed  Google Scholar 

  5. Ancelin ML, Artero S, Portet F, et al. Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ. 2006;332(7539):455–9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Carnahan RM, Lund BC, Perry PJ, et al. The relationship of an anticholinergic rating scale with serum anticholinergic activity in elderly nursing home residents. Psychopharmacol Bull. 2002;36(4):14–9.

    PubMed  Google Scholar 

  7. Villalba-Moreno AM, Alfaro-Lara ER, Pérez-Guerrero MC, et al. Systematic review on the use of anticholinergic scales in poly pathological patients. Arch Gerontol Geriatr. 2016;62:1–8.

    Article  PubMed  CAS  Google Scholar 

  8. Gnjidic D, Hilmer SN, Blyth FM, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989–95.

    Article  PubMed  Google Scholar 

  9. Campbell NL, Perkins AJ, Bradt P, et al. Association of anticholinergic burden with cognitive impairment and health care utilization among a diverse ambulatory older adult population. Pharmacotherapy. 2016;36(11):1123–31.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Mayer T, Haefeli WE, Seidling HM. Different methods, different results–how do available methods link a patient’s anticholinergic load with adverse outcomes? Eur J Clin Pharmacol. 2015;71(11):1299–314.

    Article  PubMed  CAS  Google Scholar 

  11. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Whiting P, Savović J, Higgins JP, et al. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol. 2016;69:225–34.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Aizenberg D, Sigler M, Weizman A, et al. Anticholinergic burden and the risk of falls among elderly psychiatric inpatients: a 4-year case-control study. Int Psychogeriatr. 2002;14(3):307–10.

    Article  PubMed  Google Scholar 

  14. Ehrt U, Broich K, Larsen JP, et al. Use of drugs with anticholinergic effect and impact on cognition in Parkinson’s disease: a cohort study. J Neurol Neurosurg Psychiatry. 2010;81(2):160–5.

    Article  PubMed  Google Scholar 

  15. Kolanowski A, Fick DM, Campbell J, et al. A preliminary study of anticholinergic burden and relationship to a quality of life indicator, engagement in activities, in nursing home residents with dementia. J Am Med Dir Assoc. 2009;10(4):252–7.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Campbell NL, Boustani MA, Lane KA, et al. Use of anticholinergics and the risk of cognitive impairment in an African American population. Neurology. 2010;75(2):152–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Campbell NL, Khan BA, Farber M, et al. Improving delirium care in the intensive care unit: the design of a pragmatic study. Trials. 2011;12:139.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Fox C, Livingston G, Maidment ID, et al. The impact of anticholinergic burden in Alzheimer’s dementia-the LASER-AD study. Age Ageing. 2011;40(6):730–5.

    Article  PubMed  Google Scholar 

  19. Fox C, Richardson K, Maidment ID, et al. Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. J Am Geriatr Soc. 2011;59(8):1477–83.

    Article  PubMed  Google Scholar 

  20. Cai X, Campbell N, Khan BC, et al. Long-term anticholinergic use and the aging brain. Alzheimers Dement. 2013;9(4):377–85.

    Article  PubMed  Google Scholar 

  21. Koyama A, Steinman M, Ensrud K, et al. Long-term cognitive and functional effects of potentially inappropriate medications in older women. J Gerontol A Biol Sci Med Sci. 2014;69(4):423–9.

    Article  PubMed  Google Scholar 

  22. Koyama A, Steinman M, Ensrud K, et al. Ten-year trajectory of potentially inappropriate medications in very old women: importance of cognitive status. J Am Geriatr Soc. 2013;61(2):258–63.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Pasina L, Djade CD, Lucca U, et al. Association of anticholinergic burden with cognitive and functional status in a cohort of hospitalized elderly: comparison of the anticholinergic cognitive burden scale and anticholinergic risk scale: results from the REPOSI study. Drugs Aging. 2013;30(2):103–12.

    Article  PubMed  CAS  Google Scholar 

  24. Shah RC, Janos AL, Kline JE, et al. Cognitive decline in older persons initiating anticholinergic medications. PLoS ONE. 2013;8(5):e64111.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Kidd AC, Musonda P, Soiza RL, et al. The relationship between total anticholinergic burden (ACB) and early in-patient hospital mortality and length of stay in the oldest old aged 90 years and over admitted with an acute illness. Arch Gerontol Geriatr. 2014;59(1):155–61.

    Article  PubMed  CAS  Google Scholar 

  26. Kashyap M, Belleville S, Mulsant BH, et al. Methodological challenges in determining longitudinal associations between anticholinergic drug use and incident cognitive decline. J Am Geriatr Soc. 2014;62(2):336–41.

    Article  PubMed  Google Scholar 

  27. Mangoni AA, van Munster BC, Woodman RJ, et al. Measures of anticholinergic drug exposure, serum anticholinergic activity, and all-cause postdischarge mortality in older hospitalized patients with hip fractures. Am J Geriatr Psychiatry. 2013;21(8):785–93.

    Article  PubMed  Google Scholar 

  28. Lanctôt KL, O’Regan J, Schwartz Y, et al. Assessing cognitive effects of anticholinergic medications in patients with coronary artery disease. Psychosomatics. 2014;55(1):61–8.

    Article  PubMed  Google Scholar 

  29. Sittironnarit G, Ames D, Bush AI, et al. Effects of anticholinergic drugs on cognitive function in older Australians: results from the AIBL study. Dement Geriatr Cogn Disord. 2011;31(3):173–8.

    Article  PubMed  CAS  Google Scholar 

  30. Carnahan RM, Lund BC, Perry PJ, et al. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol. 2006;46(12):1481–6.

    Article  PubMed  CAS  Google Scholar 

  31. Kersten H, Molden E, Tolo IK, et al. Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2013;68(3):271–8.

    Article  PubMed  CAS  Google Scholar 

  32. Kersten H, Molden E, Willumsen T, et al. Higher anticholinergic drug scale (ADS) scores are associated with peripheral but not cognitive markers of cholinergic blockade: cross sectional data from 21 Norwegian nursing homes. Br J Clin Pharmacol. 2013;75(3):842–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Lampela P, Lavikainen P, Garcia-Horsman JA, et al. Anticholinergic drug use, serum anticholinergic activity, and adverse drug events among older people: a population-based study. Drugs Aging. 2013;30(5):321–30.

    Article  PubMed  CAS  Google Scholar 

  34. Low LF, Anstey KJ, Sachdev P. Use of medications with anticholinergic properties and cognitive function in a young-old community sample. Int J Geriatr Psychiatry. 2009;24(6):578–84.

    Article  PubMed  Google Scholar 

  35. Juliebø V, Bjøro K, Krogseth M, et al. Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture. J Am Geriatr Soc. 2009;57(8):1354–61.

    Article  PubMed  Google Scholar 

  36. Drag L, Wright S, Bieliauskas L. Prescribing practices of anticholinergic medications and their association with cognition in an extended care setting. J Appl Gerontol. 2012;31(2):239–59.

    Article  Google Scholar 

  37. Kalisch Ellett LM, Pratt NL, Ramsay EN, et al. Multiple anticholinergic medication use and risk of hospital admission for confusion or dementia. J Am Geriatr Soc. 2014;62(10):1916–22.

    Article  PubMed  Google Scholar 

  38. Rudolph JL, Salow MJ, Angelini MC, et al. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008;168(5):508–13.

    Article  PubMed  Google Scholar 

  39. Kumpula EK, Bell JS, Soini H, et al. Anticholinergic drug use and mortality among residents of long-term care facilities: a prospective cohort study. J Clin Pharmacol. 2011;51(2):256–63.

    Article  PubMed  CAS  Google Scholar 

  40. Lowry E, Woodman RJ, Soiza RL, et al. Associations between the anticholinergic risk scale score and physical function: potential implications for adverse outcomes in older hospitalized patients. J Am Med Dir Assoc. 2011;12(8):565–72.

    Article  PubMed  Google Scholar 

  41. Lowry E, Woodman RJ, Soiza RL, et al. Clinical and demographic factors associated with antimuscarinic medication use in older hospitalized patients. Hosp Pract. 2011;39(1):30–6.

    Article  Google Scholar 

  42. Koshoedo S, Soiza RL, Purkayastha R, et al. Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation. Am J Geriatr Pharmacother. 2012;10(4):251–7.

    Article  PubMed  Google Scholar 

  43. Landi F, Dell’Aquila G, Collamati A, et al. Anticholinergic drug use and negative outcomes among the frail elderly population living in a nursing home. J Am Med Dir Assoc. 2014;15(11):825–9.

    Article  PubMed  Google Scholar 

  44. Huang K, Chan F, Shih H, et al. Relationship between potentially inappropriate anticholinergic drugs (PIADs) and adverse outcomes among elderly patients in Taiwan. J Food Drug Anal. 2012;20(4):930–7.

    CAS  Google Scholar 

  45. Bostock CV, Soiza RL, Mangoni AA. Associations between different measures of anticholinergic drug exposure and Barthel Index in older hospitalized patients. Ther Adv Drug Saf. 2013;4(6):235–45.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Dispennette R, Elliott D, Nguyen L, et al. Drug Burden Index score and anticholinergic risk scale as predictors of readmission to the hospital. Consult Pharm. 2014;29(3):158–68.

    Article  PubMed  Google Scholar 

  47. Teramura-Grönblad M, Muurinen S, Soini H, et al. Use of anticholinergic drugs and cholinesterase inhibitors and their association with psychological well-being among frail older adults in residential care facilities. Ann Pharmacother. 2011;45(5):596–602.

    Article  PubMed  CAS  Google Scholar 

  48. Walter PJ, Dieter AA, Siddiqui NY, et al. Perioperative anticholinergic medications and risk of catheterization after urogynecologic surgery. Female Pelvic Med Reconstr Surg. 2014;20(3):163–7.

    Article  PubMed  Google Scholar 

  49. Cancelli I, Valentinis L, Merlino G, et al. Drugs with anticholinergic properties as a risk factor for psychosis in patients affected by Alzheimer’s disease. Clin Pharmacol Ther. 2008;84(1):63–8.

    Article  PubMed  CAS  Google Scholar 

  50. Cancelli I, Gigli GL, Piani A, et al. Drugs with anticholinergic properties as a risk factor for cognitive impairment in elderly people: a population-based study. J Clin Psychopharmacol. 2008;28(6):654–9.

    Article  PubMed  Google Scholar 

  51. Chew ML, Mulsant BH, Pollock BG, et al. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc. 2008;56(7):1333–41.

    Article  PubMed  Google Scholar 

  52. Jessen F, Kaduszkiewicz H, Daerr M, et al. Anticholinergic drug use and risk for dementia: target for dementia prevention. Eur Arch Psychiatry Clin Neurosci. 2010;260(Suppl. 2):S111–5.

    Article  PubMed  Google Scholar 

  53. Han L, Agostini JV, Allore HG. Cumulative anticholinergic exposure is associated with poor memory and executive function in older men. J Am Geriatr Soc. 2008;56(12):2203–10.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Agar M, Currow D, Plummer J, et al. Changes in anticholinergic load from regular prescribed medications in palliative care as death approaches. Palliat Med. 2009;23(3):257–65.

    Article  PubMed  CAS  Google Scholar 

  55. Yeh YC, Liu CL, Peng LN, et al. Potential benefits of reducing medication-related anticholinergic burden for demented older adults: a prospective cohort study. Geriatr Gerontol Int. 2013;13(3):694–700.

    Article  PubMed  Google Scholar 

  56. Han L, McCusker J, Cole M, et al. Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med. 2001;161(8):1099–105.

    Article  PubMed  CAS  Google Scholar 

  57. Best O, Gnjidic D, Hilmer SN, et al. Investigating polypharmacy and drug burden index in hospitalised older people. Intern Med J. 2013;43(8):912–8.

    Article  PubMed  CAS  Google Scholar 

  58. Gnjidic D, Cumming RG, Le Couteur DG, et al. Drug Burden Index and physical function in older Australian men. Br J Clin Pharmacol. 2009;68(1):97–105.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Gnjidic D, Le Couteur DG, Abernethy DR, et al. Drug burden index and Beers criteria: impact on functional outcomes in older people living in self-care retirement villages. J Clin Pharmacol. 2012;52(2):258–65.

    Article  PubMed  Google Scholar 

  60. Gnjidic D, Le Couteur DG, Naganathan V, et al. Effects of drug burden index on cognitive function in older men. J Clin Psychopharmacol. 2012;32(2):273–7.

    Article  PubMed  Google Scholar 

  61. Gnjidic D, Bell JS, Hilmer SN, et al. Drug Burden Index associated with function in community-dwelling older people in Finland: a cross-sectional study. Ann Med. 2012;44(5):458–67.

    Article  PubMed  CAS  Google Scholar 

  62. Gnjidic D, Hilmer SN, Hartikainen S, et al. Impact of high risk drug use on hospitalization and mortality in older people with and without Alzheimer’s disease: a national population cohort study. PLoS ONE. 2014;9(1):e83224.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  63. Wilson NM, Hilmer SN, March LM, et al. Associations between drug burden index and physical function in older people in residential aged care facilities. Age Ageing. 2010;39(4):503–7.

    Article  PubMed  Google Scholar 

  64. Wilson NM, Hilmer SN, March LM, et al. Associations between drug burden index and falls in older people in residential aged care. J Am Geriatr Soc. 2011;59(5):875–80.

    Article  PubMed  Google Scholar 

  65. Wilson NM, Hilmer SN, March LM, et al. Associations between drug burden index and mortality in older people in residential aged care facilities. Drugs Aging. 2012;29(2):157–65.

    Article  PubMed  Google Scholar 

  66. Cao YJ, Mager DE, Simonsick EM, et al. Physical and cognitive performance and burden of anticholinergics, sedatives, and ACE inhibitors in older women. Clin Pharmacol Ther. 2008;83(3):422–9.

    Article  PubMed  CAS  Google Scholar 

  67. Hilmer SN, Mager DE, Simonsick EM, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167(8):781–7.

    Article  PubMed  Google Scholar 

  68. Lowry E, Woodman RJ, Soiza RL, et al. Drug burden index, physical function, and adverse outcomes in older hospitalized patients. J Clin Pharmacol. 2012;52(10):1584–91.

    Article  PubMed  Google Scholar 

  69. Lönnroos E, Gnjidic D, Hilmer SN, et al. Drug Burden Index and hospitalization among community-dwelling older people. Drugs Aging. 2012;29(5):395–404.

    Article  PubMed  Google Scholar 

  70. Dauphinot V, Faure R, Omrani S, et al. Exposure to anticholinergic and sedative drugs, risk of falls, and mortality: an elderly inpatient, multicenter cohort. J Clin Psychopharmacol. 2014;34(5):565–70.

    Article  PubMed  CAS  Google Scholar 

  71. Nishtala PS, Narayan SW, Wang T, et al. Associations of drug burden index with falls, general practitioner visits, and mortality in older people. Pharmacoepidemiol Drug Saf. 2014;23(7):753–8.

    Article  PubMed  Google Scholar 

  72. Bosboom PR, Alfonso H, Almeida OP, et al. Use of potentially harmful medications and health-related quality of life among people with dementia living in residential aged care facilities. Dement Geriatr Cogn Dis Extra. 2012;2(1):361–71.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Minzenberg MJ, Poole JH, Benton C, et al. Association of anticholinergic load with impairment of complex attention and memory in schizophrenia. Am J Psychiatry. 2004;161(1):116–24.

    Article  PubMed  Google Scholar 

  74. Whalley LJ, Sharma S, Fox HC, et al. Anticholinergic drugs in late life: adverse effects on cognition but not on progress to dementia. J Alzheimers Dis. 2012;30(2):253–61.

    Article  PubMed  CAS  Google Scholar 

  75. Boustani M, Campbell N, Munger S, et al. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health. 2008;4(3):311–20.

    Article  CAS  Google Scholar 

  76. Summers WK. A clinical method of estimating risk of drug induced delirium. Life Sci. 1978;22(17):1511–6.

    Article  PubMed  CAS  Google Scholar 

  77. Mosby. Mosby’s drug consult for health professions. C.V. Mosby Publishing Co, Missouri; 2004.

    Google Scholar 

  78. Physicians’ desk reference. 58th ed. Montvale (NJ): Thomson PDR; 2016.

  79. Gnjidic D, Hilmer SN, Blyth FM, et al. High-risk prescribing and incidence of frailty among older community-dwelling men. Clin Pharmacol Ther. 2012;91(3):521–8.

    Article  PubMed  CAS  Google Scholar 

  80. Klamer TT, Wauters M, Azermai M, et al. A novel scale linking potency and dosage to estimate anticholinergic exposure in older adults: the Muscarinic Acetylcholinergic Receptor Antagonist Exposure Scale. Basic Clin Pharmacol Toxicol. 2017;120(6):582–90.

    Article  PubMed  CAS  Google Scholar 

  81. Kouladjian L, Gnjidic D, Chen T, et al. DBI Calculator©. The Drug Burden Index Calculator  2016 [cited 2016 08 Nov 2016]; 1:[The Drug Burden Index Calculator]. Available from: https://drugburdenindex.com/Account/Login?ReturnUrl=%2f.

Download references

Author information

Authors and Affiliations

  1. Research Institute for the Care of Older People (RICE), Royal United Hospital, Combe Park, Bath, BA1 3NG, UK

    Tomas J. Welsh

  2. Royal United Hospital Bath NHS Foundation Trust, Bath, Somerset, UK

    Tomas J. Welsh

  3. University of Nottingham, Nottingham, Nottinghamshire, UK

    Veronika van der Wardt, Grace Ojo, Adam L. Gordon & John R. F. Gladman

  4. Derby Teaching Hospitals NHS Foundation Trust, Derby, Derbyshire, UK

    Adam L. Gordon

  5. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, Leicester, UK

    John R. F. Gladman

  6. University of Bristol, Bristol, UK

    Tomas J. Welsh

  7. NIHR Nottingham Biomedical Research Centre, Nottingham, Nottinghamshire, UK

    John R. F. Gladman

Authors
  1. Tomas J. Welsh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Veronika van der Wardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Grace Ojo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adam L. Gordon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John R. F. Gladman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomas J. Welsh.

Ethics declarations

Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of Interest

Tomas Welsh, Veronika Van der Wardt, Grace Ojo, Adam Gordon and John Gladman have no conflicts of interest directly relevant to the content of this review.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 28 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Welsh, T.J., van der Wardt, V., Ojo, G. et al. Anticholinergic Drug Burden Tools/Scales and Adverse Outcomes in Different Clinical Settings: A Systematic Review of Reviews. Drugs Aging 35, 523–538 (2018). https://doi.org/10.1007/s40266-018-0549-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-018-0549-z

Search

Navigation