Drugs with possible anticholinergic effects are given a score of 1. Drugs with established and clinically relevant cognitive anticholinergic effects are given a score of either 2 or 3, based on the drug blood-brain barrier permeability and its association with the development of delirium. [1-3]

Exposure to medications with anticholinergic effects are associated with reduced physical and cognitive function [4]. Anticholinergic burden is dose-related and cumulative across drugs from different classes. Use of medications with definite anticholinergic effects was associated with a 0.33-point greater decline in Mini-Mental State Examination (MMSE) score than not taking anticholinergics [5]. Each one point increase in the ACB total score has been correlated with a 26% increase in the risk of death [5].

Consider risks and benefits of continuous use of specific medications, and consider alternatives if:

References
1. Boustani, M., Campbell, N., Munger, S., Maidment, I., & Fox, C. (2008). Impact of anticholinergics on the aging brain: A review and practical application. Aging Health, 4(3), 311-320.

2. Campbell, NL, Maidment, I, Fox, C, Khan, B & Boustani, M 2013, 'The 2012 update to the anticholinergic cognitive burden scale' Journal of the American Geriatrics Society, vol. 61, no. S1, C46, pp. S142-S143.

3. Aging Brain Care. Anticholinergic Cognitive Burden Scale: 2012 update [Internet] Available from: http://www.miltonkeynesccg.nhs.uk/resources/uploads/ACB_scale_-_legal_size.pdf. Accessed 19 August 2020.

4. Kouladjian L, Gnjidic D, Chen TF, Mangoni AA, Hilmer SN. Drug Burden Index in older adults: theoretical and practical issues. Clin Interv Aging. 2014 Sep 9;9:1503-15.

5. Fox, C. , Richardson, K. , Maidment, I. D., Savva, G. M., Matthews, F. E., Smithard, D. , Coulton, S. , Katona, C. , Boustani, M. A. and Brayne, C. (2011), Anticholinergic Medication Use and Cognitive Impairment in the Older Population: The Medical Research Council Cognitive Function and Ageing Study. Journal of the American Geriatrics Society, 59: 1477-1483

6. Shannon L Risacher, Brenna C McDonald, Eileen F Tallman, John D West, Martin R Farlow, Fredrick W Unverzagt, Sujuan Gao, Malaz Boustani, Paul K Crane, Ronald C Petersen, Clifford R Jack, William J Jagust, Paul S Aisen, Michael W Weiner, Andrew J Saykin, Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults. JAMA Neurology 2016 June 1, 73 (6): 721-32

7. Mohammed Saji Salahudeen, Stephen B Duffull, Prasad S Nishtala, Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatrics 2015 March 25, 15: 31

Contributed By: