Anticholinergic Burden - Treatment Optimization

Treatment Optimization Regarding Anticholinergic Medications Potential Impact on Cognitive Test Performance

There is increasing evidence that medications with anticholinergic effects may adversely impact cognitive function. Older adults are particularly sensitive to these effects due to age-related changes in pharmacokinetics and pharmacodynamics. The cumulative impact of taking one or more medications with anticholinergic properties is known as the anticholinergic burden. To quantify this burden, Boustani et al. (2008) developed the Anticholinergic Cognitive Burden (ACB) scale. The objective of this study is to examine whether optimizing pharmacotherapy concerning drugs with anticholinergic effects-identified by both the ACB scale and the newly developed Swe-ABS-can improve cognitive test performance among individuals attending a memory clinic. Anticholinergic drug use and cognitive performance will be assessed at baseline and at a 6-month follow-up.

Study Overview

• Status: Completed
• Conditions: Cognitive Function; Anticholinergics

• Study Type: Observational
• Enrollment (Actual): 663

Contacts and Locations

Study Locations

• Sweden
  • Ängelholm, Sweden, 26281
    • Specialistminnesmottagningen

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

The study population includes individuals aged ≥ 50 at the Memory Clinic, Hospital of Ängelholm

Description

Inclusion Criteria:

• 50 years and older

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cognitive function	Mini-Mental State Examination (MMSE). Range 0-30; maximum 30 indicating preserved cognitive functioning.	6 months
Cognitive function	Montreal Cognitive Assessment (MoCA). Range 0-30; maximum 30 indicating preserved cognitive functioning.	6 months
Cognitive function	Trail Making Test (TMT) - A. Assessing visual attention and processing speed. Age-dependent e.g, 65-74 years of age 33 ± 11 seconds. Trail Making Test (TMT) - B. Assessing executive function especially cognitive flexibiity. Age-dependent e.g, 65-74 years of age 85 ± 25 seconds.	6 months
Cognitive function	Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) Neuropsychological test battery covering several cognitive domains. Age-dependent e.g, 70-79 years of age with education < 6 years: 12-16. High education: 8-12	6 months
Cognitive function	Symbol Digit Modalities Test (SDMT) Assessing attention, executive function and memory. Correctly identified symbols are recorded within a time frame of 90 seconds. Age-dependent e.g, 70-74 years of age with short education: 36. High education: 43	6 months
Cognitive function	A Quick Test of Cognitive Speed (AQT) Three moments, 1 color, 2 form and 3 color-form. Naming correctly as fast as possible.	6 months
Cognitive function	5x3 Memory Test A brief and structured memory test involving 15 concrete items grouped into five items on three subsequent sets. Scoring is based on immediate and delayed recall in a special scoring system.	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Anticholinergic burden	Anticholinergic burden, determined according to the Anticholinergic Burden scale	6 months
Cognitive function	Cognitive function, measured by Montreal Cognitive Assessment (MOCA)	6 months
Cognitive function	Cognitive function, measured by the Trail Making Test A & B (TMT)	6 months
Cognitive function	Cognitive function, measured by The Alzheimer´s Disease Assessment Scale - Cognitive subscale (ADAS-Cog)	6 months
Cognitive function	Cognitive function, measured by the Symbol Digit Modalities Test (SDMT)	6 months
Cognitive function	Cognitive function, measured by A Quick Test of cognitive speed (AQT)	6 months

Collaborators and Investigators

• Sponsor: Region Skane
• Collaborators: Angelholm Hospital
• Investigators: Principal Investigator: Per Johansson, MD, PhD, Region Skane

Publications and helpful links

General Publications

• Rube T, Ecorcheville A, Londos E, Modig S, Johansson P. Development of the Swedish anticholinergic burden scale (Swe-ABS). BMC Geriatr. 2023 Aug 25;23(1):518. doi: 10.1186/s12877-023-04225-1.

Helpful Links

• Article BMC Geriatr. 2023 Aug.25;23(1):518

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2017
• Primary Completion (Actual): September 30, 2021
• Study Completion (Actual): September 30, 2021

Study Registration Dates

• First Submitted: June 27, 2017
• First Submitted That Met QC Criteria: July 3, 2017
• First Posted (Actual): July 5, 2017

Study Record Updates

• Last Update Posted (Estimated): August 28, 2025
• Last Update Submitted That Met QC Criteria: August 21, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: cognition; anticholinergic; MMSE; alzheimer; anticholinergic cognitive burden scale
• Other Study ID Numbers: Studie ACB

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No