***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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    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 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 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 OBJECTIVE To investigate determinants of antipsychotic medication use among older people living in aged care homes in Australia . DESIGN Retrospective study of a r and om sample of de-identified medication reports using cross-sectional data gathered between 1 January 2008 and 30 June 2008 in Australia . SUBJECTS The mean ( SD ) age of the residents was 84.0 ( 9.0 ) years . Seventy-five per cent were females . MEASURES Resident demographics , clinical characteristics , medical diagnoses and prescribed medication were systematic ally recorded . Logistic regression ( LR ) models were used to determine predictors for any antipsychotic , atypical and conventional antipsychotic use . RESULTS Twenty-three per cent of the residents were prescribed one or more antipsychotics . In the LR model , factors for predicting the odds ratio and 95 % confidence interval ( CI ) for any antipsychotic medication use were agitation ( 7.11 , 95 % CI 3.15 - 16.03 ) , challenging behaviours ( 7.47 , 95 % CI 2.53 - 22.10 ) , dementia ( 2.35 , 95 % CI 1.36 - 4.06 ) , dementia with mood disorder ( 0.39 , 95 % CI 0.16 - 0.92 ) , paranoia ( 6.70 , 95 % CI 1.08 - 41.55 ) , psychosis ( 14.79 , 95 % CI 3.64 - 60.00 ) and any psychiatric diagnosis ( 3.30 , 95 % CI 1.82 - 6.00 ) . Use of atypical antipsychotic medication was significant for agitation ( 4.58 , 95 % CI 2.05 - 10.23 ) , aggression ( 2.25 , 95 % CI 1.05 - 4.78 ) , challenging behaviours ( 8.01 , 95 % CI 2.76 - 23.24 ) , dementia ( 3.64 , 95 % CI 1.99 - 6.67 ) , dementia with mood disorder ( 0.16 , 95 % CI 0.06 - 0.43 ) , psychosis ( 16.51 , 95 % CI 4.28 - 63.66 ) and any psychiatric diagnosis ( 4.44 , 95 % CI 2.33 - 8.46 ) . CONCLUSIONS Psychiatric diagnosis , psychosis and dementia were associated with significantly greater odds for the use of antipsychotic medications .  Older people suffering from dementia and comorbid mood disorders treated with antidepressants were less likely to be prescribed atypical antipsychotics 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 
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Conclusions In conclusion , there is not one st and ardised tool for measuring anticholinergic burden .
Cohort studies have shown that higher anticholinergic burden is associated with negative brain effects , poorer cognitive and functional outcomes