DOI: 10.1002/alz.079930 ISSN: 1552-5260

Anticholinergic burden and cognitive impairment. Where do we stand?

Gemma García‐Lluch, Juan Pardo, Hernán Ramos García, Miguel Baquero, Carmen Peña‐Bautista, Consuelo Cháfer‐Pericás, Lucrecia Moreno Royo
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



Polypharmacy is commonly observed among elderly patients and may increase the risk of anticholinergic burden, which is associated with frailty and cognitive impairment, among other side effects. As the long period association between anticholinergics and cognitive impairment remains under study, the present work aims to assess whether a significative anticholinergic burden is associated with cognitive impairment diagnosis.


Patients between 50 and 80 years old were recruited at the Cognitive Disorders Unit from the Hospital Universitari I Politècnic La Fe of Valencia (Spain). Medical interviews, neurological examinations, neuropsychological tests, and CSF biomarkers were assessed to classify patients as Alzheimer’s Disease (AD) patients (based on the NIA‐AA criteria), other cognitive impairment (OCI) patients (when they had other cognitive impairments than AD), and controls (cognitively healthy patients without CSF biomarkers alteration). Pharmacological history was obtained throw medical history review and classified using the ATC/DDD classification ( The CRIDECO Anticholinergic Burden Scale was applied to anticholinergic burden in all patients. A significant anticholinergic burden was considered when the overall punctuation was equal to or higher than 3 points. All the subjects signed the informed consent. This project was approved by an Ethics Committee (2020‐705‐1).


An amount of 517 patients aged between 50 and 80 years participated in the present study. From them, 274 patients had AD, 192 were OCI, and 51 were control patients. Statistical differences were found between anticholinergic burden and diagnosis. The 24% of the cohort had a significant anticholinergic burden and were mainly AD and OCI patients. OCI patients had the highest rate of anticholinergic burden (29%), followed by AD patients (25%) and control patients (17%). Women showed a higher anticholinergic burden than men (p‐value <0.05). No differences were found between anticholinergic burden and CSF AD biomarkers.


Anticholinergic medication is more prescribed among patients with cognitive impairment, compared with control patients. As these drugs may promote the detrimental effects of anticholinergic burden on cognition, it is imperative to review the medications in patients at risk of dementia, especially women.

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