The Impact of Anticholinergic Burden on Cognitive Function and Adverse Events Among Patients with Parkinson's Disease: A Meta-Analysis.

INTRODUCTION/

OBJECTIVE

Anticholinergic burden, the cumulative effect of medications with anticholinergic properties, is associated with cognitive decline and adverse health outcomes in older adults. In Parkinson's disease, anticholinergic agents are commonly prescribed to manage both motor and nonmotor symptoms, resulting in increased cumulative exposure. Despite the clinical relevance of anticholinergic burden, its effects in Parkinson's disease remain insufficiently characterized. This systematic review and meta-analysis investigated the association between anticholinergic burden and adverse outcomes in patients with Parkinson's disease.

METHODS

Eligible studies compared increased versus decreased anticholinergic burden by using validated scoring systems. PubMed, Embase, the Cochrane Library, and Web of Science were comprehensively searched for relevant articles published until February 29, 2024.

RESULTS

Eight studies met the inclusion criteria. A higher anticholinergic burden was associated with higher risks of dementia (odds ratio [OR]: 1.71; 95% CI: 0.93 to 3.17) and cognitive decline (standardized mean difference: -0.71; 95% CI: -1.51 to 0.08), but these associations were nonsignificant. Subgroup analysis revealed a significant association between anticholinergic burden and dementia in European cohorts (OR: 2.91; 95% CI: 1.02 to 8.28). A higher anticholinergic burden was significantly associated with higher risks of fracture (OR: 1.53; 95% CI: 1.28 to 1.84) and emergency department visits (OR: 1.25; 95% CI: 1.15 to 1.36).

DISCUSSION: These findings suggest that an increased anticholinergic burden in Parkinson's disease leads to adverse cognitive and physical outcomes.

CONCLUSION

Although some associations did not reach statistical significance, the results highlight the need for cautious prescribing practices and regular medication reviews in patients with Parkinson's disease.