anticholinergic cognitive burden (ACB) scale

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The anticholinergic cognitive burden (ACB) scale and other lists with similar names are methods of quantifying the risk of harm to people taking medicines with anticholinergic activity. Anticholinergic medicines are associated with an increased risk of cognitive impairment [1], falls [2] and delirium [3]

  • drugs other than those given for their anticholinergic properties, e.g. antihistamines and antipsychotics, are included on the list

  • the risk is cumulative, so to calculate the overall risk, the score is added up for each of the medicines being taken being taken. A score of three or more is significant, but risks are thought to increase further with higher scores.

 

Some examples [source 4] - this is by no means exhaustive:

 

ACB score 1

ACB score 2

ACB score 3

Atenolol

Codeine

Colchicine

Diazepam

Digoxin

Haloperidol

Fentanyl

Furosemide

Loperamide

Morphine

Nifedipine

Ranitidine

Warfarin

Carbamazepine

Pethidine

Amitriptyline

Chlorphenamine

Clozapine

Hydroxyzine

Olanzapine

Oxybutynin

Paroxetine

Promethiazine

Tolterodine

Contributor: Dr Nick Bradshaw (January 2014)

 Reference:

  • [1] Campbell N, Boustani M, Limbil T, Ott C, Fox C, Maidment I, Schubert CC, Munger S, Fick D, Miller D, Gulati R.The cognitive impact of anticholinergics: a clinical review.
    Clin Interv Aging. 2009;4:225-33. Epub 2009 Jun 9. Review.
  • [2] Aizenberg D, Sigler M, Weizman A, Barak Y.Anticholinergic burden and the risk of falls among elderly psychiatric inpatients: a 4-year case-control study.Int Psychogeriatr. 2002 Sep;14(3):307-10.
  • [3] Best O, Gnjidic D, Hilmer SN, Naganathan V, McLachlan AJ.Investigating polypharmacy and drug burden index in hospitalised older people.Intern Med J. 2013 Aug;43(8):912-8. doi: 10.1111/imj.12203.
  • [4]http://www.uea.ac.uk/mac/comm/media/press/2011/june/anticholinergics+study+drug+list

Last reviewed 01/2018