Scientific article
Open access

Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review

Published inEuropean journal of clinical pharmacology, vol. 77, no. 2, p. 147-162
Publication date2021-02
First online date2020-10-03

Purpose: Older people are at risk of anticholinergic side effects due to changes affecting drug elimination and higher sensitivity to drug's side effects. Anticholinergic burden scales (ABS) were developed to quantify the anticholinergic drug burden (ADB). We aim to identify all published ABS, to compare them systematically and to evaluate their associations with clinical outcomes.

Methods: We conducted a literature search in MEDLINE and EMBASE to identify all published ABS and a Web of Science citation (WoS) analysis to track validation studies implying clinical outcomes. Quality of the ABS was assessed using an adapted AGREE II tool. For the validation studies, we used the Newcastle-Ottawa Scale and the Cochrane tool Rob2.0. The validation studies were categorized into six evidence levels based on the propositions of the Oxford Center for Evidence-Based Medicine with respect to their quality. At least two researchers independently performed screening and quality assessments.

Results: Out of 1297 records, we identified 19 ABS and 104 validations studies. Despite differences in quality, all ABS were recommended for use. The anticholinergic cognitive burden (ACB) scale and the German anticholinergic burden scale (GABS) achieved the highest percentage in quality. Most ABS are validated, yet validation studies for newer scales are lacking. Only two studies compared eight ABS simultaneously. The four most investigated clinical outcomes delirium, cognition, mortality and falls showed contradicting results.

Conclusion: There is need for good quality validation studies comparing multiple scales to define the best scale and to conduct a meta-analysis for the assessment of their clinical impact.

  • Clinical outcomes
  • Cumulative anticholinergic burden
  • Older people
  • Quality assessment
  • Validation
  • Age Factors
  • Aged
  • Aging / psychology
  • Cholinergic Antagonists / adverse effects
  • Cognition Disorders / chemically induced
  • Cognition Disorders / epidemiology
  • Cost of Illness
  • Humans
  • Metabolic Clearance Rate / physiology
  • Outcome Assessment, Health Care / methods
  • Validation Studies as Topic
  • Druge-related side effect and adverse reactions
Citation (ISO format)
LISIBACH, Angela et al. Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review. In: European journal of clinical pharmacology, 2021, vol. 77, n° 2, p. 147–162. doi: 10.1007/s00228-020-02994-x
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Article (Published version)
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ISSN of the journal0031-6970

Technical informations

Creation03/27/2023 10:54:47 AM
First validation06/23/2023 9:45:32 AM
Update time06/23/2023 9:45:32 AM
Status update06/23/2023 9:45:32 AM
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