***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To analyze clinical , functional , mental , sociofamiliar , and evolutional characteristics of pluripathological patients ( PP ) in Primary Health Care setting . PATIENTS AND METHOD Prospect i ve , multiinstitutional cohort study in four Primary Health Care Institutions by active identification of PP from a computerized registry using the Spanish And alusian Health Care Council criteria . A clinical interview was proposed to all identified patients . The clinical data , Barthel index ( BI ) , Pfeiffer scale , clinical vulnerability ( CV ) , sociofamiliar features by the Gijon scale , and 1-year admissions and mortality were analyzed . An univariant and multivariant analysis was performed in order to know the risk factors associated to previously described variables . RESULTS Overall , 806 PP were detected ( 1.38 % of the population ) .  Cardiovascular categories were the most prevalent . A total of 662 patients ( 69 % ) were eligible for the interview .  Median BI was 90 ( 0 - 100 ) , and 24 % of patients had severe functional impairment ( BI < 60 ) . Twenty-nine percent of them had been admitted to hospital at least once in the last 3 months . Patients with more functional impairment and CV were older , having more defining categories , especially E category . A total of 174 patients ( 37.75 % ) had cognitive impairment .  This group was older , with more functional impairment , and worse sociofamiliar support . One-year mortality was 6.1 % , and was correlated with CV and older age . CONCLUSIONS The definition of PP used selects in the Primary Care setting a population with a high level of multidimensional frailty having a high prevalence of functional , cognitive deterioration , sociofamiliar problems , CV and consumption of health care re sources . Due to this multidimensional deterioration , it is recommendable to make an integral evaluation in the health care practice of these patients 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 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 Background Drugs with anticholinergic effects are associated with adverse events such as delirium and falls as well as cognitive decline and loss of independence . Objective The aim of the study was to evaluate the association between anticholinergic burden and both cognitive and functional status , according to the hypothesis that the cumulative anticholinergic burden , as measured by the Anticholinergic Cognitive Burden ( ACB ) Scale and Anticholinergic Risk Scale ( ARS ) , increases the risk of cognitive decline and impairs activities of daily living . Methods This cross-sectional , prospect i ve study ( 3-month telephone follow-up ) was conducted in 66 Italian internal medicine and geriatric wards participating in the Registry of Polytherapies SIMI ( Società Italiana di Medicina Interna ) ( REPOSI ) study during 2010 . The sample included 1,380 in patients aged 65 years or older . Cognitive status was rated with the Short Blessed Test ( SBT ) and physical function with the Barthel Index . Each patient ’s anticholinergic burden was evaluated using the ACB and ARS scores . Results The mean SBT score for patients treated with anticholinergic drugs was higher than that for patients receiving no anticholinergic medications as also indicated by the ACB scale , even after adjustment for age , sex , education , stroke and transient ischaemic attack [ 9.2 ( 95 % CI 8.6–9.9 ) vs. 8.5 ( 95 % CI 7.8–9.2 ) ; p = 0.05 ] . There was a dose – response relationship between total ACB score and cognitive impairment . Patients identified by the ARS had more severe cognitive and physical impairment than patients identified by the ACB scale , and the dose – response relationship between this score and ability to perform activities of daily living was clear . No correlation was found with length of hospital stay . Conclusions Drugs with anticholinergic properties identified by the ACB scale and ARS are associated with worse cognitive and functional performance in elderly patients . The ACB scale might permit a rapid identification of drugs potentially associated with cognitive impairment in a dose – response pattern , but the ARS is better at rating activities of daily living Objective : To compare associations between four measures of anticholinergic exposure ( anticholinergic risk scale , ARS ; anticholinergic drug burden , DBAC ; number and use versus no use of anticholinergic drugs ) , Barthel Index ( BI , physical function ) and Abbreviated Mental Test ( AMT , cognitive function ) on admission in older hospitalized patients . Methods : Prospect i ve observational study of a consecutive series of 271 older patients ( age 83 ± 7 years ) from community-dwelling and institutionalized setting s , admitted to an acute geriatric admission unit between 28 September 2011 and 18 December 2011 . The main outcome measures were BI quartiles ( primary outcome ) and AMT ( secondary outcome ) on admission . Results : Anticholinergic prevalence was 47 % . Multinomial logistic regression showed higher DBAC was associated with a greater risk of being in the lower BI quartiles versus highest BI quartile ( Q4 ) . This risk was significant for Q3 ( p = 0.04 ) and Q2 ( p = 0.02 ) but not for Q1 ( p = 0.06 ) . A greater number of anticholinergic drugs was associated with a higher risk of being in Q2 ( p = 0.02 ) . This risk was not significant for either Q3 ( p = 0.10 ) or Q1 ( p = 0.06 ) . No significant associations were observed either with use of anticholinergic medication or with ARS and BI quartiles . AMT did not show independent associations with any of the four measures of anticholinergic exposure . Conclusion : In older hospitalized patients , DBAC and some crude measures of anticholinergic exposure , but not ARS , showed independent associations with lower BI , but not AMT . These results highlight differences between various measures of anticholinergic drug exposure when study ing their associations with functional status OBJECTIVES To evaluate the association between the Drug Burden Index ( DBI ) , a measure of a person 's total exposure to anticholinergic and sedative medications that includes principles of dose-response and maximal effect and is associated with impaired physical function in community-dwelling older people , and falls in residents of residential aged care facilities ( RACFs ) . DESIGN Data were drawn from participants in a r 
    Output:
    
Exposure to anticholinergic drugs has been linked to cognitive disorders ( basically measured with Anticholinergic Risk Scale ( ARS ) , Anticholinergic Cognitive Burden Scale ( ACB ) and Drug Burden Index ( DBI ) ) and functional scale ( with ARS and DBI ) .
However , there is no clear relationship with mortality .
The Anticholinergic Drug Scale was the only one that obtained no association with any of the variables studied .
There is a great variety of scales published and applied to older patients .