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Abstract：
OBJECTIVE: This review aims to comprehensively summarize the differences in anticholinergic drug burden (ADB) scores between older hospitalized patients with and without delirium.
METHODS: We searched PubMed, Embase, Web of Science, Cochrane Library and CINAHL EBSCOhost databases to identify prospective cohort studies exploring the relationship between ADB and the occurrence of delirium in older hospitalized patients. The primary outcome of the review was the mean ADB scores for the delirium and non-delirium groups, and the secondary outcome was the scores for the subsyndromal and non-delirium groups. The standardized mean difference (SMD) and corresponding 95% confidence intervals (95% CI) were incorporated using a fixed-effect method. Moreover, we performed subgroup analysis according to the admission type, age, the ADB scale type and the ADB classification.
RESULTS: Nine prospective cohort studies involving 3791 older patients with a median age of 75.1 (71.6-83.9) were included. The ADB score was significantly higher in the delirium group than in the non-delirium group (SMD = 0.21, 95%CI 0.13-0.28). In subgroup analysis, the age subgroup was split into < 75 and ≥ 75 according to the median age of the older people. There were significant differences in ADB scores between older people with delirium and those without delirium in various subgroups: surgical (SMD = 0.20, 95%CI 0.12-0.28), internal medicine (SMD = 0.64, 95%CI 0.25-1.02), age < 75 (SMD = 0.17, 95%CI 0.08-0.26), age ≥ 75 (SMD = 0.27, 95%CI 0.15-0.39), ADS scale (SMD = 0.13, 95%CI 0.13-0.40), ARS scale (SMD = 0.15, 95%CI 0.03-0.26), ACB scale (SMD = 0.13, 95%CI 0.01-0.25), pre-admission ADB (SMD = 0.24, 95%CI 0.05-0.43) and ADB during hospitalization (SMD = 0.20, 95%CI 0.12-0.27).
CONCLUSIONS: We found a quantitative relationship between ADB and delirium in older patients admitted for internal medicine and surgery. And this relationship remained significant in different age, ADB scale type and ADB classification subgroups. However, the actual difference in ADB scores between patients with delirium and without delirium was small. More high-quality observational studies should be conducted to explore the impact of ADB on delirium and subsyndromal delirium.
BACKGROUND: The protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO) [Ref: CRD42022353649].
METHODS: We searched PubMed, Embase, Web of Science, Cochrane Library and CINAHL EBSCOhost databases to identify prospective cohort studies exploring the relationship between ADB and the occurrence of delirium in older hospitalized patients. The primary outcome of the review was the mean ADB scores for the delirium and non-delirium groups, and the secondary outcome was the scores for the subsyndromal and non-delirium groups. The standardized mean difference (SMD) and corresponding 95% confidence intervals (95% CI) were incorporated using a fixed-effect method. Moreover, we performed subgroup analysis according to the admission type, age, the ADB scale type and the ADB classification.
RESULTS: Nine prospective cohort studies involving 3791 older patients with a median age of 75.1 (71.6-83.9) were included. The ADB score was significantly higher in the delirium group than in the non-delirium group (SMD = 0.21, 95%CI 0.13-0.28). In subgroup analysis, the age subgroup was split into < 75 and ≥ 75 according to the median age of the older people. There were significant differences in ADB scores between older people with delirium and those without delirium in various subgroups: surgical (SMD = 0.20, 95%CI 0.12-0.28), internal medicine (SMD = 0.64, 95%CI 0.25-1.02), age < 75 (SMD = 0.17, 95%CI 0.08-0.26), age ≥ 75 (SMD = 0.27, 95%CI 0.15-0.39), ADS scale (SMD = 0.13, 95%CI 0.13-0.40), ARS scale (SMD = 0.15, 95%CI 0.03-0.26), ACB scale (SMD = 0.13, 95%CI 0.01-0.25), pre-admission ADB (SMD = 0.24, 95%CI 0.05-0.43) and ADB during hospitalization (SMD = 0.20, 95%CI 0.12-0.27).
CONCLUSIONS: We found a quantitative relationship between ADB and delirium in older patients admitted for internal medicine and surgery. And this relationship remained significant in different age, ADB scale type and ADB classification subgroups. However, the actual difference in ADB scores between patients with delirium and without delirium was small. More high-quality observational studies should be conducted to explore the impact of ADB on delirium and subsyndromal delirium.
BACKGROUND: The protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO) [Ref: CRD42022353649].
摘要：
目的：本综述旨在全面总结有和无谵妄的老年住院患者抗胆碱能药物负荷（ADB）评分的差异。
方法：我们搜索了PubMed，Embase,WebofScience,Cochrane图书馆和CINAHLEBSCOhost数据库用于确定前瞻性队列研究，探索ADB与老年住院患者谵妄发生之间的关系。审查的主要结果是谵妄和非谵妄组的平均ADB评分，次要结局是亚综合征组和非谵妄组的评分.使用固定效应方法合并标准化平均差(SMD)和相应的95%置信区间(95%CI)。此外，我们根据入院类型进行亚组分析，年龄,ADB量表类型和ADB分类。
结果：纳入9项前瞻性队列研究，涉及3791名年龄中位数为75.1（71.6-83.9）的老年患者。谵妄组ADB评分明显高于非谵妄组(SMD=0.21,95CI0.13～0.28)。在亚组分析中，根据老年人的中位年龄,将年龄亚组分为<75和≥75.在各种亚组中，有谵妄的老年人和无谵妄的老年人之间的ADB评分存在显着差异：手术（SMD=0.20，95CI0.12-0.28），内科（SMD=0.64，95CI0.25-1.02），年龄<75（SMD=0.17，95CI0.08-0.26），年龄≥75（SMD=0.27，95CI0.15-0.39），ADS量表（SMD=0.13，95CI0.13-0.40），ARS刻度（SMD=0.15，95CI0.03-0.26），ACB量表（SMD=0.13，95CI0.01-0.25），入院前ADB（SMD=0.24，95CI0.05-0.43）和住院期间ADB（SMD=0.20，95CI0.12-0.27）。
结论：我们发现，在内科和外科收治的老年患者中，ADB与谵妄之间存在定量关系。这种关系在不同的年龄仍然很重要，ADB量表类型及ADB分类亚组。然而,谵妄患者与无谵妄患者ADB评分的实际差异较小.应开展更多高质量的观察性研究，以探讨ADB对谵妄和亚综合征谵妄的影响。
背景：该方案发表在国际前瞻性系统审查注册中心（PROSPERO）[Ref：CRD42022353649]。
方法：我们搜索了PubMed，Embase,WebofScience,Cochrane图书馆和CINAHLEBSCOhost数据库用于确定前瞻性队列研究，探索ADB与老年住院患者谵妄发生之间的关系。审查的主要结果是谵妄和非谵妄组的平均ADB评分，次要结局是亚综合征组和非谵妄组的评分.使用固定效应方法合并标准化平均差(SMD)和相应的95%置信区间(95%CI)。此外，我们根据入院类型进行亚组分析，年龄,ADB量表类型和ADB分类。
结果：纳入9项前瞻性队列研究，涉及3791名年龄中位数为75.1（71.6-83.9）的老年患者。谵妄组ADB评分明显高于非谵妄组(SMD=0.21,95CI0.13～0.28)。在亚组分析中，根据老年人的中位年龄,将年龄亚组分为<75和≥75.在各种亚组中，有谵妄的老年人和无谵妄的老年人之间的ADB评分存在显着差异：手术（SMD=0.20，95CI0.12-0.28），内科（SMD=0.64，95CI0.25-1.02），年龄<75（SMD=0.17，95CI0.08-0.26），年龄≥75（SMD=0.27，95CI0.15-0.39），ADS量表（SMD=0.13，95CI0.13-0.40），ARS刻度（SMD=0.15，95CI0.03-0.26），ACB量表（SMD=0.13，95CI0.01-0.25），入院前ADB（SMD=0.24，95CI0.05-0.43）和住院期间ADB（SMD=0.20，95CI0.12-0.27）。
结论：我们发现，在内科和外科收治的老年患者中，ADB与谵妄之间存在定量关系。这种关系在不同的年龄仍然很重要，ADB量表类型及ADB分类亚组。然而,谵妄患者与无谵妄患者ADB评分的实际差异较小.应开展更多高质量的观察性研究，以探讨ADB对谵妄和亚综合征谵妄的影响。
背景：该方案发表在国际前瞻性系统审查注册中心（PROSPERO）[Ref：CRD42022353649]。
