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Background/Aim: The cumulative exposure to medications with anticholinergic properties is associated with various adverse health outcomes, including those affecting cognitive and functional health [1]. Research on anticholinergic burden (AB) largely focuses on older adults and clinically vulnerable populations, while less is known about its frequency and medication composition across broader age groups and measurement scales. This review aims to systematically synthesize evidence on the extent of scale-defined AB and the contributing medications in community, population-based, and outpatient settings.

Methods: This ongoing systematic review follows PRISMA 2020 reporting guidelines. PubMed, Embase, and Web of Science were searched for studies published from January 2000 onward. Eligible studies reported, or provided sufficient data to derive, the frequency of AB in community, population-based, or outpatient settings using AB scales evaluated in previous methodological reviews. We assessed the risk of bias using the Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies. Owing to substantial methodological heterogeneity, findings were synthesized descriptively.

Results: Preliminary findings indicate a geographically diverse evidence base that is nevertheless concentrated in higher-income settings and dominated by studies of older adults. The Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), and Anticholinergic Risk Scale (ARS) were the most frequently applied instruments. Reported exposure varied considerably by population, setting, scale, threshold, and exposure definition. Where age- and sex-specific data were reported, exposure was generally more frequent in older age groups and among women. Most exposed individuals were classified in lower burden categories. When comparing results within and across studies, frequency estimates based on the ACB and ADS tended to be at the higher end of the reported ranges, whereas estimates based on the ARS and Anticholinergic Activity Scale (AAS) were more often at the lower end. Cardiovascular, psychotropic, and antiallergic medications were common contributors to AB, although medication profiles varied substantially across studies and scales.

Discussion/Conclusion: Preliminary evidence suggests that AB is relevant beyond institutional and specialist-care settings and is not confined to geriatric populations. However, reported frequencies depend strongly on the scale, threshold, and exposure definition used, limiting direct comparisons between studies. These findings support examining AB across a broader adult age range in pharmacoepidemiological research. Clearer reporting of the rationale for scale choice and implementation, as well as more contemporary and transparent approaches to AB measurement, may improve comparability and interpretability across populations and settings.

Literatur

[1] Nishtala PS, Salahudeen MS, Hilmer SN. Anticholinergics: theoretical and clinical overview. Expert Opin Drug Saf. 2016 Jun;15(6):753-68. DOI: 10.1517/14740338.2016.1165664