Anticholinergic Cognitive Burden Scale shows dose-response relationship with adverse outcomes

Anticholinergic burden assessed with the Anticholinergic Cognitive Burden Scale consistently shows dose-response relationships with a variety of adverse outcomes.

In a study of long-term associations between adverse clinical outcomes in older adults and three scales for anticholinergic burden (the cumulative effect of using multiple medications that block the effects of acetylcholine in the body), the ACB showed the strongest, most consistent dose-response relationships with risk of all four adverse outcomes studied: emergency department visits, all-cause hospitalizations, hospitalizations for fractures, and incident dementia. Among those 65 to 74 years old, for example, when going from an ACB score of 1 to a score of 4 or greater, individuals' adjusted odds ratio increased from 1.41 to 2.25 for emergency department visits; from 1.32 to 1.92 for all-cause hospitalizations; from 1.10 to 1.71 for fracture-specific hospitalizations; and from 3.13 to 10.01 for incident dementia. Because medications with anticholinergic properties comprise 30 to 50 percent of all medications commonly prescribed to older adults, the authors suggest that the ACB may be a useful tool to identify high-risk populations for future research.​