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The following is a summary of “Anticholinergic Burden and Cognitive Function in Psychosis: A Systematic Review and Meta-Analysis,” published in the February 2025r issue of American Journal of Psychiatry by Mancini et al. 

Researchers conducted a retrospective study analyzing the link between anticholinergic medication and cognitive function in psychosis. They also examined whether reducing these medications improves cognition. 

They searched MEDLINE, Embase, and PsycINFO from inception to October 2023 for studies with objective cognitive assessment and anticholinergic burden quantification using clinical scales, serological anticholinergic activity, or tapering. They conducted analyses in R using the metafor package, applied random-effects meta-analysis models, and assessed heterogeneity, study quality, and meta-regressions (age, sex, and antipsychotic dosage in chlorpromazine equivalents). 

The results showed that of 1,337 citations, 40 met inclusion criteria: 25 anticholinergic burden studies (4,620 patients), 6 serological anticholinergic activity studies (382 patients), and 9 tapering studies (186 patients). Anticholinergic burden correlated negatively with global cognition (r=−0.37, 95% CI=−0.48, −0.25), verbal learning (r=−0.28, 95% CI=−0.36, −0.21), visual learning (r=−0.17, 95% CI=−0.28, −0.06), working memory (r=−0.22, 95% CI=−0.29, −0.14), processing speed (r=−0.24, 95% CI=−0.35, −0.13), attention (r=−0.19, 95% CI=−0.29, −0.08), executive functions (r=−0.17, 95% CI=−0.27, −0.06), and social cognition (r=−0.12, 95% CI=−0.19, −0.05). Serological anticholinergic activity correlated negatively with verbal learning (r=−0.26, 95% CI=−0.38, −0.14), working memory (r=−0.19, 95% CI=−0.35, −0.03), and executive functions (r=−0.16, 95% CI=−0.27, −0.04). Tapering improved verbal learning (d=0.77, 95% CI=0.44, 1.1), working memory (d=0.94, 95% CI=0.63, 1.26), and executive functions (d=0.44, 95% CI=0.26, 0.62). 

Investigators found that anticholinergic burden was associated with cognitive impairments in psychosis. They showed that tapering off anticholinergic medication may improve cognition, but randomized clinical trials were needed for unbiased quantification. 

Source: psychiatryonline.org/doi/10.1176/appi.ajp.20240260