Anticholinergic Burden Assessment Tool

A tool for finding the ACB Score of commonly prescribed medicines, and for calculating the Anticholinergic Burden for your patient.


Drugs with possible anticholinergic effects are given a score of 1. Drugs with established and clinically relevant cognitive anticholinergic effects are given a score of either 2 or 3, based on the drug blood-brain barrier permeability and its association with the development of delirium. [1-3]

Exposure to medications with anticholinergic effects are associated with reduced physical and cognitive function [4]. Anticholinergic burden is dose-related and cumulative across drugs from different classes. Use of medications with definite anticholinergic effects was associated with a 0.33-point greater decline in Mini-Mental-State Examination (MMSE) score than not taking anticholinergics [5]. Each one point increase in the ACB total score has been correlated with a 26% increase in the risk of death [5].

Consider risks and benefits of continuous use of specific medications, and consider alternatives if:

  • Patient receiving a medication that has an ACB score of 2 or 3.
  • Total ACB score is 3 or more.


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Accessed 19 August 2020.

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Fox, C. , Richardson, K. , Maidment, I. D., Savva, G. M., Matthews, F. E., Smithard, D. , Coulton, S. , Katona, C. , Boustani, M. A. and Brayne, C.

Journal of the American Geriatrics Society 2011, 59 (8): 1477-83

Shannon L Risacher, Brenna C McDonald, Eileen F Tallman, John D West, Martin R Farlow, Fredrick W Unverzagt, Sujuan Gao, Malaz Boustani, Paul K Crane, Ronald C Petersen, Clifford R Jack, William J Jagust, Paul S Aisen, Michael W Weiner, Andrew J Saykin

JAMA Neurology 2016 June 1, 73 (6): 721-32

Mohammed Saji Salahudeen, Stephen B Duffull, Prasad S Nishtala

BMC Geriatrics 2015 March 25, 15: 31

The Anticholinergic Burden Assessment Tool calculator is created by QxMD.

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1. Answer these 8 questions to receive the ACB Score and potential alternatives.

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