Potentially Inappropriate Medications and Anticholinergic Burden in Older People Attending Memory Clinics in Australia

Drugs Aging. 2016 Jan;33(1):37-44. doi: 10.1007/s40266-015-0332-3.


Background: There has been limited research into potentially inappropriate medication (PIM) use and anticholinergic burden in patients attending memory clinics.

Objectives: The aim of this study was to explore the use of PIMs related to cognitive impairment (PIMcog), anticholinergic cognitive burden (ACB) and concomitant use of anticholinergic medications with cholinesterase inhibitors (ChEIs) in patients attending memory clinics.

Methods: Cross-sectional analysis of baseline data from the Prospective Research In MEmory clinics (PRIME) study was performed. Participants were community-dwelling patients who attended nine memory clinics and had a diagnosis of mild cognitive impairment or dementia. PIMcog were defined as any medication considered potentially inappropriate for patients with cognitive impairment according to the Beers or STOPP criteria. Clinically significant ACB was defined as total score of ≥3 on the ACB scale.

Results: A total of 964 patients, mean age 77.6 years, were included. PIMcog were used by 206 (21.4%) patients. Anticholinergics and sedatives were the most common PIMcog. PIMcog use was associated with higher number of medications (adjusted OR 1.26; 95% CI 1.19-1.33) and with not having completed secondary level education (adjusted OR 1.71; 95% CI 1.01-2.89). One hundred and thirteen (11.7%) patients had a clinically significant ACB score (≥3). ChEIs were used by 575 patients and 65 (11.3%) of these had an ACB score ≥3. There was no statistically significant difference in ChEI use between patients with and without an ACB score ≥3.

Conclusion: PIMcog use, clinically significant anticholinergic burden, and concurrent use of anticholinergics with ChEIs were prevalent in patients attending memory clinics. Efforts are needed to improve prescribing for people with cognitive impairment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Australia
  • Cholinergic Antagonists / administration & dosage*
  • Cholinergic Antagonists / adverse effects
  • Cholinesterase Inhibitors / administration & dosage*
  • Cholinesterase Inhibitors / adverse effects
  • Cognition Disorders / chemically induced
  • Cognition Disorders / epidemiology*
  • Cross-Sectional Studies
  • Dementia / epidemiology*
  • Female
  • Humans
  • Male
  • Memory
  • Potentially Inappropriate Medication List
  • Prevalence
  • Prospective Studies


  • Cholinergic Antagonists
  • Cholinesterase Inhibitors