The anticholinergic burden: from research to practice

Abstract

SUMMARY Drugs with anticholinergic effects are known to cause adverse effects such as dry mouth, constipation and urinary retention. In older people drugs with anticholinergic effects may contribute to cognitive decline and a loss of functional capacity. Many drugs that are not in the anticholinergic drug class also have anticholinergic effects. They include antidepressants, antipsychotics and antihistamines. Taking multiple drugs with anticholinergic effects creates an anticholinergic burden. It is important that clinicians identify which patients are at risk. There are several tools to assess the anticholinergic burden. Clinicians can use these tools to make a pharmacological risk assessment when reviewing a patient’s medicines. This can assist decisions about continuing or stopping drugs with anticholinergic effects. Deprescribing drugs with anticholinergic effects has several potential benefits in older people. In addition to reversing adverse effects, deprescribing may prevent problems such as falls.

Patterns of a structural covariance network associated with Mild Behavioural Impairment in biologically defined Alzheimer’s Disease

“…Furthermore, total anticholinergic medication burden for each patient was calculated using the Anticholinergic Burden (ACB) score (50,51). The ACB scale categorizes medications by assigning scores ranging from 0 to 3, which are determined by their interaction with muscarinic receptors and their impact on cognitive function.…”

Pharmcokinetic and pharmacodynamic considerations for the anticholinergic burden scale of drugs

“…The Drug Burden Index (DBI) is a measure of exposure to drugs with anticholinergic and sedative effects. 55 The DBI may be one of the most commonly used and validated risk assessment scales to Additionally, the DBI enables the dose-related measurement of each drug and offers an extensive evaluation of several drug classes. Accumulating evidence indicates that the DBI is a useful indicator of adverse outcomes and functionality in older adults.…”

“…To the best of our knowledge, an optimal scale has not yet been developed to qualify the total anticholinergic burden. The Drug Burden Index (DBI) is a measure of exposure to drugs with anticholinergic and sedative effects 55 . The DBI may be one of the most commonly used and validated risk assessment scales to estimate cumulative exposure to anticholinergic medications.…”

Association of the Drug Burden Index (DBI) exposure with outcomes: A systematic review

“…For example, the American Geriatrics Society Beers Criteria® is a list of potentially inappropriate medications that are typically best avoided by older adults, 2 including some, but not all, anticholinergic and sedative medications. Anticholinergic and sedative medications are commonly prescribed in older persons and have a range of non‐specific adverse effects including sedation, confusion, and functional impairment, which older adults are particularly sensitive to 3 . There are at least 19 anticholinergic burden and two sedative load risk scales and models 4,5 .…”

“…Anticholinergic and sedative medications are commonly prescribed in older persons and have a range of non-specific adverse effects including sedation, confusion, and functional impairment, which older adults are particularly sensitive to. 3 There are at least 19 anticholinergic burden and two sedative load risk scales and models. 4,5 Anticholinergic risk and sedative load scales have been shown to be associated with adverse health outcomes in older adults.…”