Anticholinergic Burden Assessment Tool

A tool for finding the ACB Score of commonly prescribed medicines, and for calculating the Anticholinergic Burden for your patient.


Drugs with possible anticholinergic effects are given a score of 1. Drugs with established and clinically relevant cognitive anticholinergic effects are given a score of either 2 or 3, based on the drug blood-brain barrier permeability and its association with the development of delirium. [1-3]

Exposure to medications with anticholinergic effects are associated with reduced physical and cognitive function [4]. Anticholinergic burden is dose-related and cumulative across drugs from different classes. Use of medications with definite anticholinergic effects was associated with a 0.33-point greater decline in Mini-Mental-State Examination (MMSE) score than not taking anticholinergics [5]. Each one point increase in the ACB total score has been correlated with a 26% increase in the risk of death [5].

Consider risks and benefits of continuous use of specific medications, and consider alternatives if:

  • Patient receiving a medication that has an ACB score of 2 or 3.
  • Total ACB score is 3 or more.


Boustani, M., Campbell, N., Munger, S., Maidment, I., & Fox, C.

Impact of anticholinergics on the aging brain: A review and practical application.

Aging Health, 4 (3): 311-320

Campbell, NL, Maidment, I, Fox, C, Khan, B & Boustani, M.

The 2012 update to the anticholinergic cognitive burden scale.

Journal of the American Geriatrics Society, 61 (S1): S142-S143

Aging Brain Care. Anticholinergic Cognitive Burden Scale: 2012 update [Internet] Available from:

Accessed 19 August 2020.

Kouladjian L, Gnjidic D, Chen TF, Mangoni AA, Hilmer SN.

Drug Burden Index in older adults: theoretical and practical issues.

Clinical Interventions in Aging 2014, 9: 1503-15

Fox, C. , Richardson, K. , Maidment, I. D., Savva, G. M., Matthews, F. E., Smithard, D. , Coulton, S. , Katona, C. , Boustani, M. A. and Brayne, C.

Anticholinergic Medication Use and Cognitive Impairment in the Older Population: The Medical Research Council Cognitive Function and Ageing Study.

Journal of the American Geriatrics Society 2011, 59 (8): 1477-83

The Anticholinergic Burden Assessment Tool calculator is created by QxMD.

Created by on 25/04/2016

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1. Answer these 8 questions to receive the ACB Score and potential alternatives.

0/9 completed