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Anticholinergic Medication Burden
Older adults are more sensitive to the adverse impact of medications with anticholinergic effects. This article in Pharmacy Times (1) provides an overview of anticholinergic cognitive burden.
(1) Beyzarov E. The anticholinergic cognitive burden. Pharmacy Times. Published online April 9, 2012. (open access article)
Hilmer and colleagues developed a Drug Burden Index (2) with the capacity to quantify the cumulative anticholinergic impact of a medication regimen of an older adult patient. In their research, they found that anticholinergic and sedative drug exposure is associated with poorer function in community-dwelling older people. (2) Anticholinergic medications also can impair cognitive function and increase the risk of delirium and falls. (3)
(2) Hilmer SN, Mager DE, Simonsick EM, et al. A Drug Burden Index to Define the Functional Burden of Medications in Older People. Arch Intern Med. 2007;167(8):781-787. (open access article)
(3) Wilson NM, Hilmer SN, March LM, et al. Associations Between Drug Burden Index and Falls in Older People in Residential Aged Care. J Am Geriatr Soc 2011;59(5):875-880.
Rudolph and colleagues developed an Anticholinergic Risk Scale, (4) also with the goal of quantifying the cumulative anticholinergic impact of a medication regimen in an older adult.
(4) Rudolph JL, Salow MJ, Angelini MC, et al. The Anticholinergic Risk Scale and Anticholinergic Adverse Effects in Older Persons. Arch Intern Med. 2008;168(5):508-513. (open access article)
A systematic review in BMC Geriatrics (5) identified a total of seven anticholinergic rating scales and found inconsistencies in how the same medications were rated among the various scales. Their citation analysis of the individual scales showed that the Anticholinergic Cognitive Burden (ACB) scale was the most frequently validated expert based anticholinergic scale for adverse outcomes. Unfortunately, this scale has been licensed to a private entity and is now considered proprietary.
(5) Salahudeen MS, Duffull SB, and Nishtala PS. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatrics 2015;15:31. (open access article)
Anticholinergic Pocket Reference Card - developed with funding support from the Agency for Healthcare Research and Quality.