Anticholinergic Medication Burden Scales: A Systematic Review.

Area of Science:

• Pharmacology
• Geriatrics
• Clinical Pharmacy

Background:

• Anticholinergic burden (ACB) is the cumulative effect of medications with anticholinergic properties.
• ACB scales aid in identifying patients at risk of adverse effects and guiding prescribing practices.
• Existing ACB scales show significant variability, lacking a recognized gold standard, which can lead to inconsistent risk assessment and suboptimal patient care.

Purpose of the Study:

• To systematically review anticholinergic burden scales, examining their medication lists, development, and scoring methodologies.
• To summarize the clinical outcomes associated with different anticholinergic burden scales.

Main Methods:

• A systematic literature search was conducted up to January 2025, including studies proposing novel or updated ACB scales.
• Independent review and data extraction by two reviewers using a custom tool based on expert consensus.
• Narrative synthesis of findings from 21 included studies.

Main Results:

• Significant variability exists in the number of medications included (27-217) and the scoring of high-potency drugs (74% inconsistent).
• Scale development often relied on literature review and expert opinion, with geographical origin and methodology influencing variability.
• Inconsistent consideration of factors like dosage across scales impacted clinical relevance, as reflected in outcome studies.

Conclusions:

• No definitive gold standard anticholinergic burden scale was identified in the review.
• Scales with comprehensive drug coverage and consideration for individual variability appear more clinically relevant.
• A need exists for a universal, clinically accessible scoring system to mitigate risks of anticholinergic polypharmacy.