American Journal of Psychiatry Audio April 2025: Anticholinergic Burden and Cognitive Function in Psychosis: A Systematic Review and Meta-Analysis
Apr 1, 2025
In this insightful discussion, Dr. Valentina Mancini, a researcher at Oxford University, delves into the effects of anticholinergic burden on cognition among schizophrenia patients, emphasizing the importance of medication management. She highlights the balance needed between medication benefits and cognitive impairments and calls for further rigorous studies. Dr. Ned Kalin, Editor-in-Chief of The American Journal of Psychiatry, contextualizes recent research findings, reinforcing the need for innovative treatment strategies to optimize patient care.
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Anticholinergic Burden Worsens Cognition
- Higher anticholinergic burden correlates with greater cognitive impairment across multiple domains in schizophrenia.
- Tapering anticholinergic medications can improve cognition in some patients.
Minimize Total Anticholinergic Load
- Assess total anticholinergic burden before prescribing and minimize unnecessary anticholinergic use.
- Adjust antipsychotic regimens or use the lowest effective anticholinergic dose to protect cognition.
Confounders Limit Current Evidence
- Existing studies limit meta-analysis conclusions because many confounders were unreported.
- Severity of negative symptoms and polypharmacy may drive both medication exposure and cognitive outcomes.