This site uses cookies to measure how you use the website so it can be updated and improved based on your needs and also uses cookies to help remember the notifications you’ve seen, like this one, so that we don’t show them to you again. If you could also tell us a little bit about yourself, this information will help us understand how we can support you better and make this site even easier for you to use and navigate.

Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: a randomized controlled trial


Kersten, H., Molden, E., Tolo, I. K., Skovlund, E., Engedal, K., Wyller, T. B.


The Journals Of Gerontology. Series A, Biological Sciences And Medical Sciences, Volume: 68, No.: 3, Pages.: 271-278

Year of Publication



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 randomized, 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 randomly allocated (1:1) to intervention or control. The intervention was a pharmacist-initiated reduction of ADS score after multidisciplinary drug reviews. 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.;

Bibtex Citation

@article{Kersten_2012, doi = {10.1093/gerona/gls176}, url = {}, year = 2012, month = {sep}, publisher = {Oxford University Press ({OUP})}, volume = {68}, number = {3}, pages = {271--278}, author = {H. Kersten and E. Molden and I. K. Tolo and E. Skovlund and K. Engedal and T. B. Wyller}, title = {Cognitive Effects of Reducing Anticholinergic Drug Burden in a Frail Elderly Population: A Randomized Controlled Trial}, journal = {The Journals of Gerontology Series A: Biological Sciences and Medical Sciences} }


administration & dosage, adverse effects, aged, 80 and over, anticholinergic, blood, cholinergic antagonists, cognition, drug utilization review, drugs, female, frail elderly, humans, in, male, mental recall, neuropsychological tests, nursing homes, of, pharmacists, reduction, salivation, use

Countries of Study


Types of Dementia

Mild Cognitive Impairment (MCI)

Types of Study

Randomised Controlled Trial

Type of Outcomes

Cognition, Service use or cost reductions (incl. hospital use reduction, care home admission delay)


Nursing Homes

Type of Interventions

Pharmaceutical Interventions, Workforce oriented interventions

Pharmaceutical Interventions


Workforce Interventions

Professional Training / Continuing Professional Development