Anticholinergic burden is associated with adverse outcomes in a middle-aged population

Many common prescription medications for urinary problems and muscle spasms, as well over- the-counter medications for cold, cough and allergies, share an anticholinergic property. The use of multiple medications in this class can lead to negative cumulative effects referred to as anticholinergic burden. ACB is known to increase the risk for future adverse events like falls, dementia, heart attack, stroke, and death. Guidelines recommend against using anticholinergic medications for geriatric patients, but little is known about their effect on middle-aged patients.

A variety of assessment scales are available for doctors and researchers to calculate a patient’s risk of ACB. A study of more than 500,000 middle-aged adults, aged 37 to 73 years in the United Kingdom, compared 10 of those scales to assess their accuracy in predicting risk for future adverse events. Researchers found that all 10 ACB scales identified individuals at higher risk for heart attack, stroke and death, after adjusting for sociodemographic and baseline health factors. Each scale also had significant predictive accuracy for falls and dementia.

While the study showed consistent association between ACB and adverse outcomes, regardless of which scale was used, the populations identified as being at risk varied considerably depending on which scale was used. Less than one in four people detected to be at risk by one scale were also detected by the other three most frequently used scales. This variation across scales has implications for clinical practice and research interventions to target ACB.

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Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties

Frances S. Mair, MD, et al

University of Glasgow, Institute of Health and Wellbeing, Department of General Practice and Primary Care, Glasgow, Scotland, United Kingdom

Post-embargo published article link (goes live March 9, 2020, 5pm Eastern)


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