LAUSR

Neurologists are familiar with the use of anticholinergic drugs for a variety of conditions including nausea and vomiting, vertigo and bladder dysfunction, a range of indications that reflects the wide distribution of acetylcholine receptors—muscarinic and nicotinic—in the central and peripheral nervous system. The side effect profile of this group of drugs is well recognised, particularly in the frail and the elderly in whom drowsiness, glaucoma, retention of urine, confusion, constipation and hallucinations are common. What may be less familiar to prescribers is the range of drugs that are not traditionally thought of as “anticholinergic” but which have anticholinergic effects which may be of clinical relevance, particularly when these drugs are used in combination. Examples include antihistamines, antidepressants and antipsychotics, and less likely candidates such as warfarin and antiarrythmics. The Anticholinergic Cognitive Burden (ACB) scale has been developed to stratify the effect different drugs could have on cognitive function as a result of their anticholinergic properties. Possible anticholinergics (e.g., aripiprazole, haloperidol, venlafaxine) are given a score of 1 and definites anticholinergics a score of 2 (e.g., carbamazepine, pimozide) or 3 (e.g., amitriptyline, doxepin). Using the ACB scale, three large European populationbased studies have examined the association of prescribed anticholinergic drugs with cognitive impairment in realworld populations, and the results are of clinical relevance to all prescribers. Anticholinergic drugs and risk of dementia: case–control study