Anticholinergic Burden Assessment Tool
A tool for finding the ACB Score of commonly prescribed medicines, and for calculating the Anticholinergic Burden for your patient.
Antidepressants, antipsychotics, drugs for anxiety and nicotine dependence
Anticonvulsants, anti-parkinsons, opioids
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 . 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 . Each one point increase in the ACB total score has been correlated with a 26% increase in the risk of death .
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.
Boustani, M., Campbell, N., Munger, S., Maidment, I., & Fox, C.
Campbell, NL, Maidment, I, Fox, C, Khan, B & Boustani, M.
Aging Brain Care. Anticholinergic Cognitive Burden Scale: 2012 update [Internet] Available from:
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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.
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Mohammed Saji Salahudeen, Stephen B Duffull, Prasad S Nishtala