The risk of cognitive impairment in older people can be increased by medications with a high anticholinergic burden.  These medications are also associated with an increased risk of dementia and death.  

A variety of anticholinergic burden calculators are available online with slight variations in the score assigned to each medication.  Ardens templates link to the ACB calculator and Medichec websites enabling clinicians to choose which scoring system they use.   

These can aid a clinician in their medication review, so that alternative medications with a lower anticholinergic burden can be considered if they would be appropriate for the patient.  Values from the ACB calculator (www.acbcalc.com) have been used in the following Ardens resources.

ACB scale template

The ACB scale template has been designed so that the ACB score can be recorded using a coded numerical field.  This will enter the code XagBE (Anticholinergic Cognitive Burden Scale score) into the patient’s record.  Previous assessments of the ACB scale are visible on the right hand pane as shown in the screenshot below.

Links to this template are located on the Polypharmacy page of the Drug Review template and on relevant formularies eg. Urge incontinence.  These serve as reminders when prescribing common medications associated with an anticholinergic effect or when conducting medication reviews.

Reports

There is a batch of reports available within Clinical Reporting > Ardens > Prescribing > Alerts | Anticholinergics.  These can be run at practice level to identify vulnerable groups on anticholinergic medications.  Following review and discussion with the patient, offending medications can be switched to an alternative, dose reduced or stopped to reduce the risk of harm.  

On an individual level, any patients identified by these reports will be highlighted with an alert in the view found on the Drug Review template, and many other templates including the LTC template.

Practice level data can be viewed on Ardens Manager.  For more information about accessing this, please see ardensmanager.com