Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties

Peter Hanlon, Terence J. Quinn, Katie Gallacher, Phyo Kyaw Myint, Bhautesh Dinesh Jani, Barbara I. Nicholl, Richard Lowrie, Roy L. Soiza, Samuel R. Neal, Duncan Lee, Frances Mair (Corresponding Author)

Research output: Contribution to journalArticlepeer-review

34 Citations (Scopus)


PURPOSE Anticholinergic burden (ACB), the cumulative effect of anticholinergic medications, is associated with adverse outcomes in older people but is less studied in middle-aged populations. Numerous scales exist to quantify ACB. The aims of this study were to quantify ACB in a large cohort using the 10 most common anticholinergic scales, to assess the association of each scale with adverse outcomes, and to assess overlap in populations identified by each scale.

METHODS We performed a longitudinal analysis of the UK Biobank community cohort (502,538 participants, baseline age: 37-73 years, median years of follow-up: 6.2). The ACB was calculated at baseline using 10 scales. Baseline data were linked to national mortality register records and hospital episode statistics. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular event (MACE). Secondary outcomes were all-cause mortality, MACE, hospital admission for fall/fracture, and hospital admission with dementia/delirium. Cox proportional hazards models (hazard ratio [HR], 95% CI) quantified associations between ACB scales and outcomes adjusted for age, sex, socioeconomic status, body mass index, smoking status, alcohol use, physical activity, and morbidity count.

RESULTS Anticholinergic medication use varied from 8% to 17.6% depending on the scale used. For the primary outcome, ACB was significantly associated with all-cause mortality/MACE for each scale. The Anticholinergic Drug Scale was most strongly associated with mortality/MACE (HR = 1.12; 95% CI, 1.11-1.14 per 1-point increase in score). The ACB was significantly associated with all secondary outcomes. The Anticholinergic Effect on Cognition scale was most strongly associated with dementia/delirium (HR = 1.45; 95% CI, 1.3-1.61 per 1-point increase).

CONCLUSIONS The ACB was associated with adverse outcomes in a middle- to older-aged population. Populations identified and effect size differed between scales. Scale choice influenced the population identified as potentially requiring reduction in ACB in clinical practice or intervention trials.
Original languageEnglish
Pages (from-to)148-155
Number of pages8
JournalAnnals of Family Medicine
Issue number2
Publication statusPublished - 31 Mar 2020

Bibliographical note

KG is funded through a Stroke Association HRH Princess Margaret Clinical Lectureship Award 2017/01. TQ funded through a Joint Stroke Association and Chief Scientist Office Senior Clinical Lectureship. BDJ funded through NHS Research for Scotland (NRS) Career Research Fellowship.


  • anticholinergic burden
  • polypharmacy
  • multimorbidity
  • mortality
  • cardiovascular events
  • Cardiovascular events
  • Polypharmacy
  • Mortality
  • Anticholinergic burden
  • Multimorbidity


Dive into the research topics of 'Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties'. Together they form a unique fingerprint.

Cite this