The 2012 update to the anticholinergic cognitive burden scale

N.L. Campbell, I. Maidment, C. Fox, B. Khan, M. Boustani

Research output: Contribution to journalConference abstractpeer-review


Background: In 2008, the Anticholinergic Cognitive Burden (ACB) scale was generated through a combination of laboratory data, literature review, and expert opinion. This scale identified an increased risk in mortality and worsening cognitive function in multiple populations, including 13,000 older adults in the United Kingdom. We present an updated scale based on new information and new medications available to the market.
Methods: We conducted a systematic review for publications recognizing medications with adverse cognitive effects due to anti-cholinergic properties and found no new medications since 2008.Therefore we identified medications from a review of newly ap-proved medications since 2008 and medications identified throughthe clinical experience of the authors. To be included in the updatedACB scale, medications must have met the following criteria; ACBscore of 1: evidence from in vitro data that the medication has antag-onist activity at muscarinic receptors; ACB score of 2: evidence fromliterature, prescriber’s information, or expert opinion of clinical anti-cholinergic effect; ACB score of 3: evidence from literature, pre-scriber’s information, or expert opinion of the medication causingdelirium. Results: The reviewer panel included two geriatric pharmacists,one geriatric psychiatrist, one geriatrician, and one
hospitalist.Twenty-three medications were eligible for review and possible inclu-sion in the updated ACB scale. Of these, seven medications were ex-cluded due to a lack of evidence for anticholinergic activity. Of the re-maining 16 medications, ten had laboratory evidence ofanticholinergic activity and added to the ACB list with a score of one.One medication was added with a score of two. Five medicationswere included in the ACB scale with a score of three.Conclusions: The revised ACB scale provides an update of med-ications with anticholinergic effects that may increase the risk of cog-nitive impairment. Future updates will be routinely conducted tomaintain an applicable library of medications for use in clinical andresearch environments.
Original languageEnglish
Article numberC46
Pages (from-to)S142-S143
Number of pages2
JournalJournal of the American Geriatrics Society
Issue numberS1
Publication statusPublished - Apr 2013
Event2013 AGS annual scientific meeting - Grapevine, TX, United States
Duration: 2 May 20135 May 2013

Bibliographical note

Special Issue: 2013 Annual Scientific Meeting Abstract Book.
2013 American Geriatrics Society annual scientific meeting, Grapevine, TX (US), 2-5 May 2013


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