Anticholinergic burden (ACB) and cognitive decline

Long-term use of medications with anticholinergic properties has been associated with cognitive and functional decline among older adults.

A study investigated the use of anticholinergic medication and cognitive function (1):

• participants were evaluated in three study waves (2008‐2010, 2012‐2014, and 2017‐2019)
  • anticholinergic Cognitive Burden (ACB) was calculated based on the medications in use
  • cognitive performance was evaluated using a standardized battery of tests (immediate recall, late recall, recognition, semantic and phonemic verbal fluency, and the trail‐making tests)
• total of 15,105 participants were recruited and 2,040 were excluded, leaving 13,065 participants whose data were analyzed
  • participants had a mean age of 51.7±9.0 years old, 55% were women, and 53% were white
  • during the follow‐up time, the ACB burden was associated with a decline in global cognition, memory performance and executive function
• study authors concluded:
  • during eight years of follow‐up, the ACB burden was associated with cognitive decline, particularly in the memory and executive function domains

In study (n=983), higher total daily ACB scale score was associated with poorer integrated cognitive-functional measures in older adults, underscoring the importance of monitoring anticholinergic burden and considering deprescribing to preserve independence (2):

• based on combined measures in assessing cognitive-functional decline in older adults, this study evidence supports incorporating anticholinergic burden assessment into routine care, particularly for patients aged ≥85 or those with CNS diseases and depression

Reference:

1. dos Santos ANM et al. Anticholinergic burden and cognitive decline: findings from the ELSA‐Brasil cohort study. Alzheimers Dement. 2025 Jan 9;20(Suppl 7):e089124.
2. Raad EB et al. The longitudinal association between anticholinergic burden and cognitive-functional decline among older adults. Br J Clin Pharmacol. 2026 Jan 21.