Low 2009.

Study characteristics
Methods	Design: retrospective cohort Setting: community Country: Australia Duration of follow‐up: 4 years Covariates controlled for: age, gender, education, depression, and self‐rated health
Participants	Participants numbers: 2058 Population type: 'young old' Sex: 48% women (992) Age (mean): 62 years
Prognostic factors	Anticholinergic burden measurement method: ADS scale
Outcomes	Outcomes assessed: cognitive decline; MCI Outcome ascertainment MCI: independent clinical assessment via expert Outcome ascertainment cognitive decline: a neuropsychological assessment Diagnostic criteria MCI: Jack 1999 criteria Diagnostic criteria cognitive decline: scores on cognitive testing
Source of funding	National Health and Medical Research Council grants
Notes
Item	Authors' judgement	Support for judgement
Study participation	Unclear	Sample was restricted to 'young old' (aged 60–64 years) and had high mean education (14 years).
Study attrition	Unclear	87% of participants followed up. Comparison of lost to follow‐up vs followed up participants conducted but showed people lost to follow‐up were more likely to be on anticholinergic medicine.
Prognostic factor measurement	Unclear	Anticholinergic drug use reported at baseline and 4‐year follow‐up. Used self‐reported medication use but only 1 method employed. No measurement of frequency, duration, or dose.
Outcome measurement	No	No blinding to anticholinergic burden during clinical diagnosis, but anticholinergic burden likely measured retrospectively. MCI was defined according to dated criteria (Jack 1999 rather than Peterson). MMSE used to assess cognition but study had high education mean and displays a ceiling effect.
Study confounding	Unclear	Controlled for age, sex, and comorbidities that cover both physical and psychiatric domains. However, minimal comorbidities.
Reverse causation	No	Excluded people with dementia at baseline but did not seem to be any formal restriction in anticholinergic drug use and time of outcome assessment at 4 years.
Statistical analysis and reporting	No	No protocol and no assumptions checked. Also analysis for MCI outcome was underpowered as only 38 MCI cases at follow‐up.