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Yeh Y-C, Liu C-L, Peng L-N, Lin M-H, Chen L-K. Potential benefits of reducing medication-related anticholinergic burden for demented older adults: A prospective cohort study. Geriatr Gerontol Int. 2013;13(3):694–700. Fox C, Richardson K, Maidment ID, Savva GM, Matthews FE, Smithard D, et al. Anticholinergic medication use and cognitive impairment in the older population: The medical research council cognitive function and ageing study. J Am Geriatr Soc. 2011;59(8):1477–83. The associations between anticholinergic burden and mobility have been found using AB scales to measure anticholinergic exposure [ 8] and have inspired intervention studies to determine ways to ameliorate the supposed negative association between AB and mobility. Squires et al. [ 9] investigated whether two different interventions could negate the association between AB and adverse effects such as mobility. In the study, AB was quantified using one of the several AB scales available in the literature. AB scales are tools designed to measure antic Carriere I, Fourrier-Reglat A, Dartigues JF, Rouaud O, Pasquier F, Ritchie K, et al. Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study. Arch Intern Med. 2009;169(14):1317–24. In 2014, a group of 40 medical and non-medical addiction experts from 21 EU countries came to the same conclusion ( 10). This survey included 20 substances ( 10). In the interim, as in other Western countries, there have been shifting patterns of substance abuse trends as well as political framework conditions in Germany, especially
Tune LE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry. 2001;62 Suppl 21:11–4. of Psychiatry, Psychotherapy and Psychosomatic, Johanniter Hospital Oberhausen, Oberhausen, Germany
Psychotherapy and Psychosomatics, Landschaftsverband Westfalen-Lippe-Hospital Marsberg, Marsberg, Germany Kumpula EK, Bell JS, Soini H, Pitkala KH. Anticholinergic drug use and mortality among residents of long-term care facilities: a prospective cohort study. J Clin Pharmacol. 2011;51(2):256–63. Sittironnarit G, Ames D, Bush AI, ET AL. (2011) Effects of anticholinergic drugs on cognitive function in older Australians: results from the AIBL study. Dement Geriatr Cogn Disord. doi: 10.1159/000325171. Thirteen per cent of people starting drug treatment in Great Britain in 2018 reported primary use of powder cocaine. There has been a notable increase in the proportion of people starting treatment for powder cocaine use in Scotland and Wales in recent years. Lowry E, Woodman RJ, Soiza RL, Mangoni AA. Associations between the anticholinergic risk scale score and physical function: potential implications for adverse outcomes in older hospitalized patients. J Am Med Dir Assoc. 2011;12(8):565–72.
Boustani M, Campbell N, Munger S, Maidment I, Fox C. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health. 2008;4(3):311–20. Kashyap M, Belleville S, Mulsant BH, Hilmer SN, Paquette A, le Tu M, et al. Methodological challenges in determining longitudinal associations between anticholinergic drug use and incident cognitive decline. J Am Geriatr Soc. 2014;62(2):336–41. UB: conception and design. MSp: analysis of the data. UB and MSp: collection and interpretation of data. UB: drafting the article. All authors: revising it critically for important intellectual content. Conflict of Interest The primary aim of this review was to compare anticholinergic burden quantified by the anticholinergic risk scales and evaluate associations with physical, cognitive outcomes in older people. From the most recent surveys, the prevalence of any drug use in the last year was 9.4% in England and Wales, 12% in Scotland, and 5.9% in Northern Ireland.
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Medicines with anticholinergic properties are frequently prescribed in the older population for various medical conditions [ 1]. The cumulative effect of taking one or more medicines with anticholinergic properties is referred to as anticholinergic burden [ 2]. The majority of medicines commonly prescribed to older people are not routinely recognised as having anticholinergic activity and empirically physicians prescribe these medicines based on their anticipated therapeutic benefits overlooking the risk of cumulative anticholinergic burden [ 3].
The Anticholinergic Risk Scale (ARS) score was developed based on a ranking system developed by Rudolph et al. [ 19]. A literature review of 500 medicines known to possess anticholinergic activity was conducted by a group of geriatricians and pharmacists within the Veterans Affairs Boston Healthcare System. The authors considered the affinity for the muscarinic receptor, experimental reporting of anticholinergic activity, and literature review on anticholinergic adverse effects. This information was used to rank medicines for anticholinergic activity on a scale of 0 to 3, with 0 indicating no known anticholinergic activity and 3 indicating definite/high anticholinergic activity. A total of 49 medicines with known anticholinergic activity were reported in the ARS scale. The clinical outcomes validated using the ARS scale were cognitive, functional, quality of life, length of hospital stay, and mortality. The ARS was validated in a veteran’s population derived from a single medical centre limiting its external validity. Higher ARS scores in veteran and primary care patients were shown to be associated with anticholinergic adverse events [ 19].Cai X, Campbell N, Khan B, Callahan C, Boustani M. Long-term anticholinergic use and the aging brain. Alzheimers Dement. 2013;9(4):377–85. The definition of any drug has changed over time. For more detailed descriptions on what drugs are included in each year, see Section 1 of the accompanying dataset. New psychoactive substances
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