Table 1.
Overview of included anticholinergic burden scales and sedative load models
| Scale/model; country; year of development | Age of population studied | Method of development | Scale points (no–high) |
Medications included (N) | Dose consideration applied | Methods to calculate total drugs burden | Limitations |
|---|---|---|---|---|---|---|---|
| ADS; USA; 2006 | 64–102 years | EO + assessment of SAA | 0–3 | 520 | Yes | Summation of individual scores | The categorization of drugs using ADS ratings is a technique of limited precision and has not been updated since first publication |
| ABC; France; 2006 | > 60 years without dementia | EO + literature review + assessment of SAA | 2–3 | 27 | No | Summation of average estimated clinical effects of specific drugs | Low number of medications and no consideration of dose |
| ARS; USA; 2008 | > 65 years | EO + literature review | 1–3 | 49 | Yes | Summation of individual scores | Medications reviewed were limited to those taken by members of the Veterans Affairs Boston Healthcare System. Limited numbers of drugs were included in the scale, drugs that scored 0 were not published or included in the scale |
| ACB; USA; 2008 | Mean age 73 years | EO + literature review | 1–3 | 88 | No | Summation of individual scores | The scale did not provide a comprehensive list and did not consider dose |
| AAS; Norway; 2010 | Mean age 74 years with PD | EO + existing scale involving assessment of SAA | 0–4 | 99 | No | Summation of individual scores | The population used for scale development might not be representative, and no consideration of dose was made |
|
ACL/ALS; Australia; 2011 |
> 60 years with mild cognitive impairment, AD, and healthy patients | The CrAS and ABC scale methods + EO | 0–3 | 292 | No | ACL score of the highest scoring anticholinergic drug | Scale developed by combining previously published lists of SAAs of medication with clinician-rated anticholinergic scores and providing anticholinergic scores for medications in the Australian Imaging, Biomarkers and Lifestyle study, which had no available data for their anticholinergic activities. No consideration of dose was reported |
| AEC; UK; 2016 | Not applicable | Review of the BNF through in vitro anticholinergic potency, capacity to cross the BBB and statements made in standard texts | 0–3 | 122 | No | Not applicable | Scale developed based on in vitro antimuscarinic activity, which does not account for varying drug dosages, pharmacokinetics, or differences as a result of individual patient physiology. Similarly, BBB penetration is variable and can be affected by age, sex, and other factors, including dementia |
|
German ACB; Germany; 2018 |
Not applicable | EO + literature review | 0–3 | 504 | No | In a retrospective analysis to tailor the German ACB list to the clinical setting, summation of individual scores was applied | Scale based on previously published ACB scale and did not provide a comprehensive list to include all drugs approved in Germany |
| Brazilian ACB; Brazil; 2019 | Not applicable | EO + literature review | 1–3 | 125 | No | Not applicable | Scale not validated and did not use a comprehensive literature search strategy. No consideration of dose was reported |
| KABS; Korea; 2019 | Not applicable | EO + literature review | 0–3 | 494 | No | Not applicable | Scale developed based on using medications previously rated inconsistently through expert consensus that is not necessarily correct. No consideration of dose was reported |
| mACB; Australia; 2019 | Mean age 84 years | Based on ACB and ARS scales but with modifications: when drugs were scored differently in the two scales, the higher score was considered | 1–3 | 82 | No | Summation of individual scores | Scoring based on highest value, no clinical outcome or expert opinion and no consideration of dose |
| SLM; Finland; 2003 | Not applicable | EO | 0–4 | 900 | No | Not applicable | Not updated, no dose consideration |
| Sloane model; USA; 2008 | 66 pts, aged 65–80 years, from two dementia-specific care facilities | EO, modified from the SLM | 0–4 | 60 | Yes | Summation of individual scores based on sedative potency, dose, and average daily maintenance dose for each medication | Limited number of drugs, not updated |
AAS Anticholinergic Activity Scale, ABC Anticholinergic Burden Classification, ACB Anticholinergic Cognitive Burden scale, ACL Anticholinergic Loading Scale, AD Alzheimer’s disease, ADS Anticholinergic Drug Scale, AEC Anticholinergic Effect on Cognition, ALS Anticholinergic Loading Scale, ARS Anticholinergic Rating Scale, BBB blood–brain barrier, BNF British National Formulary, CrAS Clinician-Rated Anticholinergic Score, EO expert opinion, KABS Korean Anticholinergic Burden Scale, mACB modified Anticholinergic Cognitive Burden scale, PD Parkinson’s disease, SAA serum anticholinergic activity, SLM sedative load model