***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND Observational studies report a relationship between anticholinergic drug scale ( ADS ) score and cognitive function . This study investigated whether a reduced ADS score improved cognitive function in a frail elderly population . METHODS This r and omized , controlled , single-blinded trial , recruited long-term residents with an ADS score of greater than or equal to 3 from 22 nursing homes in Norway . The participants were r and omly allocated ( 1:1 ) to intervention or control . The intervention was a pharmacist-initiated reduction of ADS score after multidisciplinary drug review s. Primary end point was Consortium to Establish a Registry for Alzheimer 's Disease 10-wordlist test for immediate recall . Secondary end points were Mini-Mental Sate Examination , delayed recall and recognition of words , saliva flow , and serum anticholinergic activity (SAA).The participants were retested after 4 and 8 weeks , and the study groups were compared after adjusting for baseline differences . RESULTS Eighty-seven patients were included . The median ADS score was reduced by 2 units ( p < .0001 ) in the intervention group and remained unchanged in the control group . After 8 weeks , the adjusted mean difference in immediate recall was 0.54 words between the intervention and control group ( 95 % confidence interval [ CI ] : -0.91 , 2.05 ; p = .48 ) . The study groups did not differ significantly in any of the other cognitive end points , salvia flow , or SAA at either follow-up ( p > .18 ) . CONCLUSION Pharmacist-initiated drug changes significantly reduced ADS score but did not improve cognitive function  in nursing home residents . Moreover , the drug changes did not reduce SAA or mouth dryness significantly , which might indicate limited applicability of the ADS score to prevent prescription risks in this population The use of prescription drugs in older people is high and many commonly prescribed drugs have anticholinergic effects . We examined the relationship between ACB on mortality and in-patient length of stay in the oldest old hospitalised population . This was a retrospective analysis of prospect i ve audit using hospital audit data from acute medical admissions in three hospitals in Engl and and Scotl and . Baseline use of possible or definite anticholinergics was determined according to the Anticholinergic Cognitive Burden Scale . The main outcome measures were decline in-hospital mortality , early in-hospital mortality at 3- and 7-days and in-patient length of stay .  A total of 419 patients ( including 65 patients with known dementia ) were included [ median age=92.9 , inter-quartile range ( IQR ) 91.4 - 95.1 years ] . 256 ( 61.1 % ) were taking anticholinergic medications .  Younger age , greater number of pre-morbid conditions , ischemic heart disease , number of medications , higher urea and creatinine levels were significantly associated with higher total ACB burden on univariate regression analysis . There were no significant differences observed in terms of in-patient mortality , in-patient hospital mortality within 3- and 7-days and likelihood of prolonged length of hospital stay between ACB categories . Compared to those without cardiovascular disease , patients with cardiovascular disease showed similar outcome regardless of ACB load ( either = 0 or > 0 ACB ) . We found no association between ACB and early ( within 3- and 7-days ) and in-patient mortality and hospital length of stay outcomes in this cohort of oldest old in the acute medical admission setting Background Delirium prevalence in the intensive care unit ( ICU ) is high . Numerous psychotropic agents are used to manage delirium in the ICU with limited data regarding their efficacy or harms . Methods / Design This is a r and omized controlled trial of 428 patients aged 18 and older suffering from delirium and admitted to the ICU of Wishard Memorial Hospital in Indianapolis . Subjects assigned to the intervention group will receive a multicomponent pharmacological management protocol for delirium ( PMD ) and those assigned to the control group will receive no change in their usual ICU care . The primary outcomes of the trial are ( 1 ) delirium severity as measured by the Delirium Rating Scale revised-98 ( DRS-R-98 ) and ( 2 ) delirium duration as determined by the Confusion Assessment Method for the ICU ( CAM-ICU ) . The PMD protocol targets the three neurotransmitter systems thought to be compromised in delirious patients : dopamine , acetylcholine , and gamma-aminobutyric acid . The PMD protocol will target the reduction of anticholinergic medications and benzodiazepines , and introduce a low-dose of haloperidol at 0.5 - 1 mg for 7 days . The protocol will be delivered by a combination of computer ( artificial intelligence ) and pharmacist ( human intelligence ) decision support system to increase adherence to the PMD protocol . Discussion The proposed study will evaluate the content and the delivery process of a multicomponent pharmacological management program for delirium in the ICU.Trial Registration Clinical Trials.gov : BACKGROUND Adverse effects of anticholinergic medications may contribute to events such as falls , delirium , and cognitive impairment  in older patients . To further assess this risk , we developed the Anticholinergic Risk Scale  ( ARS ) , a ranked categorical list of commonly prescribed medications with anticholinergic potential . The objective of this study was to determine if the ARS score could be used to predict the risk of anticholinergic adverse effects in a geriatric evaluation and management ( GEM ) cohort and in a primary care cohort . METHODS Medical records of 132 GEM patients were review ed retrospectively for medications included on the ARS and their result ant possible anticholinergic adverse effects . Prospect ively , we enrolled 117 patients , 65 years or older , in primary care clinics ; performed medication reconciliation ; and asked about anticholinergic adverse effects . The relationship between the ARS score and the risk of anticholinergic adverse effects was assessed using Poisson regression analysis . RESULTS Higher ARS scores were associated with increased risk of anticholinergic adverse effects in the GEM cohort ( crude relative risk [ RR ] , 1.5 ; 95 % confidence interval [ CI ] , 1.3 - 1.8 ) and in the primary care cohort ( crude RR , 1.9 ; 95 % CI , 1.5 - 2.4 ) . After adjustment for age and the number of medications , higher ARS scores increased the risk of anticholinergic adverse effects in the GEM cohort ( adjusted RR , 1.3 ; 95 % CI , 1.1 - 1.6 ; c statistic , 0.74 ) and in the primary care cohort ( adjusted RR , 1.9 ; 95 % CI , 1.5 - 2.5 ; c statistic , 0.77 ) . CONCLUSION Higher ARS scores are associated with statistically significantly increased risk of anticholinergic adverse effects in older patients Abstract Objective To assess the potential of anticholinergic drugs as a cause of  non-degenerative mild cognitive impairment in elderly people . Design Longitudinal cohort study . Setting 63 r and omly selected general practice s in the Montpellier region of southern France . Participants 372 people aged > 60 years without dementia at recruitment . Main outcome measures Anticholinergic burden from drug use , cognitive examination , and neurological assessment . Results 9.2 % of subjects continuously used anticholinergic drugs during the year before cognitive assessment . Compared with non-users , they had poorer performance on reaction time , attention , delayed non-verbal memory , narrative recall , visuospatial construction , and language tasks but not on tasks of reasoning , immediate and delayed recall of wordlists , and implicit memory . Eighty per cent of the continuous users were classified as having mild cognitive impairment compared with 35 % of non-users , and anticholinergic drug use was a strong predictor of mild cognitive impairment ( odds ratio 5.12 , P = 0.001 ) . No difference was found between users and non-users in risk of developing dementia at follow-up after eight years . Conclusions Elderly people taking anticholinergic drugs  had significant deficits in cognitive functioning and were highly likely to be classified as mildly cognitively impaired , although not at increased risk for dementia . Doctors should assess current use of anticholinergic drugs in elderly people with mild cognitive impairment before considering administration of acetylcholinesterase inhibitors OBJECTIVES To examine the longitudinal relationship between cumulative exposure to anticholinergic medications and memory and executive function in older men . DESIGN Prospect i ve cohort study . SETTING A Department of Veterans Affairs primary care clinic . PARTICIPANTS Five hundred forty-four community-dwelling men aged 65 and older with diagnosed hypertension . MEASUREMENTS The outcomes were measured using the Hopkins Verbal Recall Test ( HVRT ) for short-term memory and the instrumental activity of daily living ( IADL ) scale for executive function at baseline and during follow-up . Anticholinergic medication use was ascertained using participants ' primary care visit records and quantified as total anticholinergic burden using a clinician-rated anticholinergic score . RESULTS Cumulative exposure to anticholinergic medications over the preceding 12 months was associated with poorer performance on the HVRT and IADLs . On average , a 1-unit increase in the total anticholinergic burden per 3 months was associated with a 0.32-point ( 95 % confidence interval (CI)= 0.05 - 0.58 ) and 0.10-point ( 95 % CI=0.04 - 0.17 ) decrease in the HVRT and IADLs , respectively , independent of other potential risk factors for cognitive impairment , including age , education , cognitive and physical function , comorbidities , and severity of hypertension . The association was attenuated but remained statistically significant with memory ( 0.29 , 95 % CI=0.01 - 0.56 ) and executive function ( 0.08 , 95 % CI=0.02 - 0.15 ) after further adjustment for concomitant non-anticholinergic medications . CONCLUSION Cumulative anticholinergic exposure across multiple medications over 1 year may negatively affect verbal memory and executive function in older men . Prescription of drugs with anticholinergic effects in older persons deserves continued attention to avoid deleterious adverse effects Although there is an underst and able emphasis on the side effects of individual medications , the cumulative effects of medications have received little attention in palliative care prescribing . Anticholinergic load reflects a cumulative effect of medications that may account for several symptoms and adverse health outcomes frequently encountered in palliative care . A secondary analysis of 304 participants in a r and omised controlled trial had their cholinergic load calculated using the Clinician-Rated Anticholinergic Scale ( modified version ) longitudinally as death approached from medication data collected prospect ively by study nurses on each visit . Mean time from referral to death was 107 days , and mean 4.8 visits were conducted in which data were collected . Relationships to key factors were explored . Data showed that  anticholinergic load rose as death approached because of increasing use of medications for symptom control . Symptoms significantly associated with increasing anticholinergic load included dry mouth and difficulty concentrating ( P < 0.05 ) . There were also significant associations with increasing anticholinergic load and decreasing functional status ( Australia-modified Karnofsky Performance Scale ; and quality of life ( P < 0.05 ) . This study has documented in detail the longitudinal anticholinergic load associated with medications used in a palliative care population between referral and death , demonstrating the biggest contributor to anticholinergic load in a palliative care population is from symptom-specific medications , which increased as death approached AIM Increasing evidence from experimental studies and clinical observations suggests that drugs with anticholinergic properties can cause physical and mental impairment . The aim of the present study was to evaluate the relationship between the use of drugs with anticholinergic activity and negative outcomes in older nursing home residents . METHODS We used data from the data base of the U.L.I.S.S.E project ( Un Link Informatico sui Servizi Sanitari Esistenti per l'Anziani ) , a prospect i ve multicenter observational study . Patients from 31 facilities in Italy were assessed at baseline and at 6 and 12 months by trained personnel , using the Minimum Data Set for Nursing Home ( MDS-NH ) . The only exclusion criterion was age younger than 65 years . The Anticholinergic Risk Scale ( ARS ) , a list of commonly prescribed drugs with potential anticholinergic effects , was used to calculate the anticholinergic load . RESULTS A total population of 1490 patients was analyzed ; almost half of the sample ( 48 % ) was using drugs with anticholinergic properties . The population of patients with ARS 1 or higher had a higher comorbidity index ( P < .003 ) and greater cognitive impairment ( CPS 5 - 6 ) ( P < .007 ) . They were more likely to suffer from heart failure , Parkinson disease , depression , anxiety , and schizophrenia . In multivariate analysis , a higher score in the ARS scale was associated with a greater likelihood of functional decline ( described as the loss of ≥1 ADL point ) ( odds ratio [ OR ] 1.13 ; confidence interval [ CI ] 1.03 - 
    Output:
    
The Drug Burden Index was the most commonly used scale or tool in community and data base studies , while the Anticholinergic Risk Scale was used more frequently in care homes and hospital setting s. 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 .