Anticholinergic medications are frequently used by older adults.
They act on muscarinic acetylcholine receptors and antagonise
the effects of acetylcholine by competitively binding to these receptors. Usually,
they are used to manage a wide range of clinical conditions, including urinary
frequency, urgency and incontinence, irritable bowel syndrome, depression,
psychosis, chronic obstructive pulmonary disease and Parkinson's disease.
Unfortunately, simultaneously they are associated with a wide range of adverse
effects to which elderly patients are particularly sensitive. Most common adverse effects include 1dry mouth, constipation, urinary retention, falls, blurred vision
and delirium. Anticholinergic burden refers to the cumulative effect of taking
multiple medications with anticholinergic effects. Over the past few decades
many scales have been developed to measure anticholinergic burden. These scales
usually rank the anticholinergic activity of medications into 3-5 levels, ranging
from no anticholinergic activity (O) to definite anticholinergic activity (3 to
5). There is high variability in existing scales; there is still no consensus on the
definition, and both the number and ranking of the anticholinetgic medications
listed vary considerably between the scales. Also, some scales consider the
impact of different routes of administration when ranking the anticholinergic
activity of medications, while others exclude topical, ophthalmic, and inhaled
preparations. Future imperative is developing of one reference composite
anticholinergic scale which would be a useful tool for clinicians to identify medications
with anticholinergic activity
